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Yang JCH, Han B, De La Mora Jiménez E, Lee JS, Koralewski P, Karadurmus N, Sugawara S, Livi L, Basappa NS, Quantin X, Dudnik J, Ortiz DM, Mekhail T, Okpara CE, Dutcus C, Zimmer Z, Samkari A, Bhagwati N, Csőszi T. Pembrolizumab With or Without Lenvatinib for First-Line Metastatic NSCLC With Programmed Cell Death-Ligand 1 Tumor Proportion Score of at least 1% (LEAP-007): A Randomized, Double-Blind, Phase 3 Trial. J Thorac Oncol 2023:S1556-0864(23)02432-2. [PMID: 38159809 DOI: 10.1016/j.jtho.2023.12.023] [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] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/22/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Lenvatinib plus pembrolizumab was found to have antitumor activity and acceptable safety in previously treated metastatic NSCLC. We evaluated first-line lenvatinib plus pembrolizumab versus placebo plus pembrolizumab in metastatic NSCLC in the LEAP-007 study (NCT03829332/NCT04676412). METHODS Patients with previously untreated stage IV NSCLC with programmed cell death-ligand 1 tumor proportion score of at least 1% without targetable EGFR/ROS1/ALK aberrations were randomized 1:1 to lenvatinib 20 mg or placebo once daily; all patients received pembrolizumab 200 mg every 3 weeks for up to 35 cycles. Primary end points were progression-free survival (PFS) per Response Evaluation Criteria in Solid Tumors version 1.1 and overall survival (OS). We report results from a prespecified nonbinding futility analysis of OS performed at the fourth independent data and safety monitoring committee review (futility bound: one-sided p < 0.4960). RESULTS A total of 623 patients were randomized. At median follow-up of 15.9 months, median (95% confidence interval [CI]) OS was 14.1 (11.4‒19.0) months in the lenvatinib plus pembrolizumab group versus 16.4 (12.6‒20.6) months in the placebo plus pembrolizumab group (hazard ratio = 1.10 [95% CI: 0.87‒1.39], p = 0.79744 [futility criterion met]). Median (95% CI) PFS was 6.6 (6.1‒8.2) months versus 4.2 (4.1‒6.2) months, respectively (hazard ratio = 0.78 [95% CI: 0.64‒0.95]). Grade 3 to 5 treatment-related adverse events occurred in 57.9% of patients (179 of 309) versus 24.4% (76 of 312). Per data and safety monitoring committee recommendation, the study was unblinded and lenvatinib and placebo were discontinued. CONCLUSIONS Lenvatinib plus pembrolizumab did not have a favorable benefit‒risk profile versus placebo plus pembrolizumab. Pembrolizumab monotherapy remains an approved treatment option in many regions for first-line metastatic NSCLC with programmed cell death-ligand 1 tumor proportion score of at least 1% without EGFR/ALK alterations.
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Affiliation(s)
- James Chih-Hsin Yang
- Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan, Republic of China.
| | - Baohui Han
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | | | - Jong-Seok Lee
- Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | | | | | - Shunichi Sugawara
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Lorenzo Livi
- Department of Experimental and Biomedical Sciences Mario Serio, University of Florence and Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Naveen S Basappa
- Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Xavier Quantin
- IRCM, INSERM, University of Montpellier, ICM, Montpellier, France
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Llovet JM, Kudo M, Merle P, Meyer T, Qin S, Ikeda M, Xu R, Edeline J, Ryoo BY, Ren Z, Masi G, Kwiatkowski M, Lim HY, Kim JH, Breder V, Kumada H, Cheng AL, Galle PR, Kaneko S, Wang A, Mody K, Dutcus C, Dubrovsky L, Siegel AB, Finn RS. Lenvatinib plus pembrolizumab versus lenvatinib plus placebo for advanced hepatocellular carcinoma (LEAP-002): a randomised, double-blind, phase 3 trial. Lancet Oncol 2023; 24:1399-1410. [PMID: 38039993 DOI: 10.1016/s1470-2045(23)00469-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Systemic therapies have improved the management of hepatocellular carcinoma, but there is still a need to further enhance overall survival in first-line advanced stages. This study aimed to evaluate the addition of pembrolizumab to lenvatinib versus lenvatinib plus placebo in the first-line setting for unresectable hepatocellular carcinoma. METHODS In this global, randomised, double-blind, phase 3 study (LEAP-002), patients aged 18 years or older with unresectable hepatocellular carcinoma, Child Pugh class A liver disease, an Eastern Cooperative Oncology Group performance status of 0 or 1, and no previous systemic treatment were enrolled at 172 global sites. Patients were randomly assigned (1:1) with a central interactive voice-response system (block size of 4) to receive lenvatinib (bodyweight <60 kg, 8 mg/day; bodyweight ≥60 kg, 12 mg/day) plus pembrolizumab (200 mg every 3 weeks) or lenvatinib plus placebo. Randomisation was stratified by geographical region, macrovascular portal vein invasion or extrahepatic spread or both, α-fetoprotein concentration, and Eastern Cooperative Oncology Group performance status. Dual primary endpoints were overall survival (superiority threshold at final overall survival analysis, one-sided p=0·019; final analysis to occur after 532 events) and progression-free survival (superiority threshold one-sided p=0·002; final analysis to occur after 571 events) in the intention-to-treat population. Results from the final analysis are reported. This study is registered with ClinicalTrials.gov, NCT03713593, and is active but not recruiting. FINDINGS Between Jan 17, 2019, and April 28, 2020, of 1309 patients assessed, 794 were randomly assigned to lenvatinib plus pembrolizumab (n=395) or lenvatinib plus placebo (n=399). Median age was 66·0 years (IQR 57·0-72·0), 644 (81%) of 794 were male, 150 (19%) were female, 345 (43%) were Asian, 345 (43%) were White, 22 (3%) were multiple races, 21 (3%) were American Indian or Alaska Native, 21 (3%) were Native Hawaiian or other Pacific Islander, 13 (2%) were Black or African American, and 46 (6%) did not have available race data. Median follow up as of data cutoff for the final analysis (June 21, 2022) was 32·1 months (IQR 29·4-35·3). Median overall survival was 21·2 months (95% CI 19·0-23·6; 252 [64%] of 395 died) with lenvatinib plus pembrolizumab versus 19·0 months (17·2-21·7; 282 [71%] of 399 died) with lenvatinib plus placebo (hazard ratio [HR] 0·84; 95% CI 0·71-1·00; stratified log-rank p=0·023). As of data cutoff for the progression-free survival final analysis (April 5, 2021), median progression-free survival was 8·2 months (95% CI 6·4-8·4; 270 events occurred [42 deaths; 228 progressions]) with lenvatinib plus pembrolizumab versus 8·0 months (6·3-8·2; 301 events occurred [36 deaths; 265 progressions]) with lenvatinib plus placebo (HR 0·87; 95% CI 0·73-1·02; stratified log-rank p=0·047). The most common treatment-related grade 3-4 adverse events were hypertension (69 [17%] of 395 patients in the lenvatinib plus pembrolizumab group vs 68 [17%] of 395 patients) in the lenvatinib plus placebo group), increased aspartate aminotransferase (27 [7%] vs 17 [4%]), and diarrhoea (25 [6%] vs 15 [4%]). Treatment-related deaths occurred in four (1%) patients in the lenvatinib plus pembrolizumab group (due to gastrointestinal haemorrhage and hepatorenal syndrome [n=1 each] and hepatic encephalopathy [n=2]) and in three (1%) patients in the lenvatinib plus placebo group (due to gastrointestinal haemorrhage, hepatorenal syndrome, and cerebrovascular accident [n=1 each]). INTERPRETATION In earlier studies, the addition of pembrolizumab to lenvatinib as first-line therapy for advanced hepatocellular carcinoma has shown promising clinical activity; however, lenvatinib plus pembrolizumab did not meet prespecified significance for improved overall survival and progression-free survival versus lenvatinib plus placebo. Our findings do not support a change in clinical practice. FUNDING Eisai US, and Merck Sharp & Dohme, a subsidiary of Merck.
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Affiliation(s)
- Josep M Llovet
- Division of Liver Diseases, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; August Pi i Sunyer Biomedical Research Institute, University of Barcelona Hospital Clinic Barcelona, Barcelona, Spain.
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Philippe Merle
- Hepatology Unit, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Tim Meyer
- Royal Free London NHS Foundation Trust, London, UK; University College London Cancer Institute, University College London, London, UK
| | - Shukui Qin
- GI Cancer Center, Nanjing Tianyinshan Hospital, Nanjing, China
| | | | - Ruocai Xu
- Hunan Cancer Hospital, Changsha, Hunan, China
| | - Julien Edeline
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Baek-Yeol Ryoo
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Zhenggang Ren
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Gianluca Masi
- Department of Translational Research and New Technologies in Medicine and Surgery, Division of Medical Oncology, Pisa University Hospital, Pisa, Italy
| | | | | | - Jee Hyun Kim
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Valeriy Breder
- N N Blokhin Russian Cancer Research Center, Moscow, Russia
| | | | - Ann-Lii Cheng
- National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan
| | | | - Shuichi Kaneko
- Department of Gastroenterology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | | | | | | | | | | | - Richard S Finn
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Motzer RJ, Taylor MH, Evans TRJ, Okusaka T, Glen H, Lubiniecki GM, Dutcus C, Smith AD, Okpara CE, Hussein Z, Hayato S, Tamai T, Makker V. Lenvatinib dose, efficacy, and safety in the treatment of multiple malignancies. Expert Rev Anticancer Ther 2022; 22:383-400. [PMID: 35260027 PMCID: PMC9484451 DOI: 10.1080/14737140.2022.2039123] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 12/23/2021] [Accepted: 02/03/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Lenvatinib is an oral multitargeted tyrosine kinase inhibitor that has shown efficacy and manageable safety across multiple cancer types. The recommended starting doses for lenvatinib differ across cancer types and indications based on whether it is used as monotherapy or as combination therapy. AREAS COVERED This review covers clinical trials that established the dosing paradigm and efficacy of lenvatinib and defined its adverse-event profile as a monotherapy; or in combination with the mTOR inhibitor, everolimus; or the anti-PD-1 antibody, pembrolizumab; and/or chemotherapy. EXPERT OPINION Lenvatinib has been established as standard-of-care either as a monotherapy or in combination with other anticancer agents for the treatment of radioiodine-refractory differentiated thyroid carcinoma, hepatocellular carcinoma, renal cell carcinoma, and endometrial carcinoma, and is being investigated further across several other tumor types. The dosing and adverse-event management strategies for lenvatinib have been developed through extensive clinical trial experience. Collectively, the data provide the rationale to start lenvatinib at the recommended doses and then interrupt or dose reduce as necessary to achieve required dose intensity for maximized patient benefit. The adverse-event profile of lenvatinib is consistent with that of other tyrosine kinase inhibitors, and clinicians are encouraged to review and adopt relevant symptom-management strategies.
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Affiliation(s)
- Robert J. Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY, USA
| | - Matthew H. Taylor
- Division of Hematology and Oncology, Earle A. Chiles Research Institute, Providence Portland Medical Center, Portland, OR, USA
| | - Thomas R. Jeffry Evans
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- Medical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hilary Glen
- Medical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Gregory M. Lubiniecki
- Global Clinical Development, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA
| | | | | | | | - Ziad Hussein
- Clinical Pharmacology Science, Eisai Europe Ltd., Hatfield, UK
| | - Seiichi Hayato
- Clinical Pharmacology Science, Eisai Co., Ltd., Tokyo, Japan
| | | | - Vicky Makker
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY, USA
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Brose MS, Panaseykin Y, Konda B, de la Fouchardiere C, Hughes BGM, Gianoukakis AG, Joo Park Y, Romanov I, Krzyzanowska MK, Leboulleux S, Binder TA, Dutcus C, Xie R, Taylor MH. A Randomized Study of Lenvatinib 18 mg vs 24 mg in Patients With Radioiodine-Refractory Differentiated Thyroid Cancer. J Clin Endocrinol Metab 2022; 107:776-787. [PMID: 34664662 PMCID: PMC8852210 DOI: 10.1210/clinem/dgab731] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Lenvatinib is a multikinase inhibitor approved to treat radioiodine-refractory differentiated thyroid cancer (RR-DTC) at a starting dose of 24 mg/day. This study explored, in a double-blinded fashion, whether a starting dose of 18 mg/day would provide comparable efficacy with reduced toxicity. METHODS Patients with RR-DTC were randomized to lenvatinib 24 mg/day or 18 mg/day. The primary efficacy endpoint was objective response rate as of week 24 (ORRwk24); the odds ratio noninferiority margin was 0.4. The primary safety endpoint was frequency of grade ≥3 treatment-emergent adverse events (TEAEs) as of week 24. Tumors were assessed using RECIST v1.1. TEAEs were monitored and recorded. RESULTS The ORRwk24 was 57.3% (95% CI 46.1, 68.5) in the lenvatinib 24-mg arm and 40.3% (95% CI 29.3, 51.2) in the lenvatinib 18-mg arm, with an odds ratio (18/24 mg) of 0.50 (95% CI 0.26, 0.96). As of week 24, the rates of TEAEs grade ≥3 were 61.3% in the lenvatinib 24-mg arm and 57.1% in the lenvatinib 18-mg arm, a difference of -4.2% (95% CI -19.8, 11.4). CONCLUSION A starting dose of lenvatinib 18 mg/day did not demonstrate noninferiority compared to a starting dose of 24 mg/day as assessed by ORRwk24 in patients with RR-DTC. The results represent a clinically meaningful difference in ORRwk24. The safety profile was comparable, with no clinically relevant difference between arms. These results support the continued use of the approved starting dose of lenvatinib 24 mg/day in patients with RR-DTC and adjusting the dose as necessary.
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Affiliation(s)
- Marcia S Brose
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Jefferson Health, Philadelphia, PA, USA
- Correspondence: Marcia S. Brose, MD, PhD, Sidney Kimmel Cancer Center, Jefferson Torresdale Hospital, 10800 Knights Rd, 3rd floor, Philadelphia, PA 19114, USA. E-mail: .; Previous Affiliation: M.S.B., Department of Otorhinolaryngology, Head and Neck Surgery, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.; Current Affiliation: M.S.B., Department of Medical Oncology, Sidney Kimmel Cancer Center, Jefferson Health, Philadelphia, PA, USA
| | - Yury Panaseykin
- A. Tsyb Medical Radiological Research Center, Branch of the NMRС of Radiology, Obninsk, Russian Federation
| | - Bhavana Konda
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Brett G M Hughes
- Department of Cancer Care Services, Royal Brisbane and Women’s Hospital, University of Queensland, Queensland, Australia
| | - Andrew G Gianoukakis
- The Lundquist Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles/Torrance, CA, USA
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ilia Romanov
- Department of Head and Neck Tumors, N.N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | - Monika K Krzyzanowska
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Sophie Leboulleux
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy, Villejuif, France
| | - Terri A Binder
- Oncology Clinical Research, Eisai Inc., Woodcliff Lake, NJ, USA
| | - Corina Dutcus
- Oncology Clinical Research, Eisai Inc., Woodcliff Lake, NJ, USA
| | - Ran Xie
- Biostatistics, Eisai Inc., Woodcliff Lake, NJ, USA
| | - Matthew H Taylor
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR, USA
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Makker V, Aghajanian C, Cohn A, Romeo M, Bratos R, Brose M, Messing M, Dutta L, Dutcus C, Huang J, Schmidt E, Orlowski R, Taylor M. 354 Lenvatinib and pembrolizumab in advanced endometrial carcinoma (EC): long-term efficacy and safety update from a phase 1b/2 study. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundLenvatinib is a multikinase inhibitor of VEGFR 1–3, FGFR 1–4, PDGFRα, RET, and KIT. Pembrolizumab is an anti-programmed death-1 monoclonal antibody. We previously reported results from a cohort of 108 patients with metastatic EC (data cutoff date, January 10, 2019) who received lenvatinib + pembrolizumab as part of an ongoing multicenter, open-label, phase 1b/2 study evaluating the combination treatment in patients with selected solid tumors (NCT02501096). Lenvatinib + pembrolizumab showed a tolerable safety profile and promising antitumor activity per immune-related (ir) Response Evaluation Criteria In Solid Tumors (RECIST) by investigator assessment, including an objective response rate (ORR) of 38.9% (95% confidence interval [CI], 29.7–48.7), median progression-free survival (PFS) of 7.4 months (95% CI, 5.3–8.7), and median overall survival (OS) of 16.7 months (95% CI, 15.0-not estimable).1 Here we present updated efficacy and safety data (data cutoff date: August 18, 2020).MethodsPatients included in the EC cohort had histologically confirmed, measurable metastatic EC and had received ≤2 prior chemotherapies (unless discussed with the sponsor). Patients received lenvatinib (20 mg orally once daily) and pembrolizumab (200 mg intravenously once every 3 weeks). The phase 2 efficacy endpoints included ORR, PFS, OS, and duration of response. Tumor assessments for primary and secondary endpoints were evaluated by investigators per irRECIST.ResultsThe 108 patients from the key efficacy analysis set for the previously reported results were all included in these updated analyses. Median follow-up duration for the study was 34.7 months. Efficacy outcomes are summarized in table 1. Treatment-related adverse events (TRAEs) occurred in 104 (96%) patients (94 [87%] grade ≤3, 10 [9%] grade ≥4). TRAEs led to study-drug interruption of 1 or both drugs in 80 (74.1%) patients and dose reductions of lenvatinib in 73 (67.6%) patients; 23 (21.3%) patients discontinued 1 or both drugs due to a TRAE. The most common grade ≥3 TRAEs were hypertension (33.3%), lipase increased (9.3%), fatigue (8.3%), and diarrhea (7.4%).Abstract 354 Table 1ConclusionsWith extended follow-up, our updated efficacy analysis continued to show clinical benefit in patients with metastatic EC who received lenvatinib + pembrolizumab. Moreover, the combination had a manageable safety profile that was generally consistent with the established safety profiles of the individual monotherapies. No new safety signals were detected. A phase 3 study of lenvatinib + pembrolizumab versus treatment of physician’s choice in advanced endometrial cancer further supports the lasting clinical benefits observed in our study.2Trial Registration www.clinicaltrials.gov NCT02501096ReferencesMakker V, Taylor MH, Aghajanian C, et al. Lenvatinib plus pembrolizumab in patients with advanced endometrial cancer. J Clin Oncol 2020;38(26):2981–2992.Makker V, Colombo N, Casado Herráez A, et al. A multicenter, open-label, randomized, phase 3 study to compare Ethics ApprovalThis study was approved by the following ethics committees/institutional review boards (IRBs): Oregon Health & Sciences University IRB, IntegReview IRB, Memorial Sloan Kettering Cancer Center IRB, University of Pennsylvania Office of Regulatory Affairs IRB, Dana-Farber Cancer Institute IRB, The University of Chicago Biological Sciences Division IRB, University of Texas MD Anderson Cancer Center IRB, Western IRB, Quorum Review IRB, US Oncology, Inc. IRB, CEIm - Comité de Ética de la Investigación con Medicamentos, Regional Komite for Medisinsk og Helsefagli Forskningsetikk, and REC - Regional Committees for Medical and Health Research Ethics. All participants gave informed consent before taking part in this study.ConsentNo identifying information is contained in this abstract so no permission from participants is considered necessary.
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Makker V, Taylor M, Aghajanian C, Cohn A, Brose M, DiSimone C, Cao A, Suttner L, Loboda A, Cristescu R, Jelinic P, Snyder A, Nebozhyn M, Lunceford J, Orlowski R, Dutta L, Matsui J, Dutcus C, Minoshima Y, Messing M. 796P Association between biomarkers and clinical outcomes of lenvatinib (L) + pembrolizumab (P) in advanced endometrial cancer (EC): Results from KEYNOTE-146/study 111. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Chung HC, Saada-Bouzid E, Muñoz FL, Yanez E, Im SA, Castanon E, Graham DM, Garcia-Corbacho J, Lopez J, Ghori R, Dutcus C, Smith A, Norwood K, Gomez-Roca C. Abstract PS12-07: Lenvatinib plus pembrolizumab for previously treated, advanced triple-negative breast cancer: Early results from the multicohort phase 2 LEAP-005 study. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps12-07] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: Triple-negative breast cancer (TNBC) is associated with poor survival outcomes and treatment options are limited. These tumors lack therapeutic targets and become rapidly resistant to chemotherapy. The anti–PD-1 antibody pembrolizumab showed durable antitumor activity and manageable safety in patients with TNBC in the KEYNOTE-012, KEYNOTE-086, and KEYNOTE-119 studies. The combination of lenvatinib, an antiangiogenic multiple receptor tyrosine kinase inhibitor, with pembrolizumab has shown promising clinical outcomes in early-phase clinical trials across several cancer types. LEAP-005 (ClinicalTrials.gov, NCT03797326) is an ongoing study evaluating the efficacy and safety of lenvatinib combined with pembrolizumab in patients with previously treated advanced solid tumors. Here, we report the first results from the TNBC cohort of LEAP-005. Methods: This ongoing, multicohort, open-label, phase 2 study enrolled patients aged ≥18 y with previously treated, histologically or cytologically confirmed advanced TNBC. PD-L1 expression was assessed at a central laboratory using the PD-L1 IHC 22C3 pharmDx assay and measured using the combined positive score (CPS; number of PD-L1–positive tumor cells, lymphocytes, and macrophages divided by total number of tumor cells x 100). Patients received lenvatinib 20 mg once daily orally plus pembrolizumab 200 mg every 3 weeks intravenously for a maximum of 35 pembrolizumab doses, then lenvatinib alone until progressive disease or unacceptable toxicity. Primary endpoints were objective response rate (ORR) by blinded independent central review per RECIST version 1.1 and safety. Key secondary endpoints were disease control rate (DCR; defined as best overall response of complete response [CR], partial response [PR], or stable disease [SD] per RECIST v1.1), duration of response (DOR), progression-free survival (PFS), and overall survival (OS). Safety was monitored through 30 days after the last dose of study drug (90 days for serious AEs), with AEs graded using NCI CTCAE v4.0. Results: 31 patients have been enrolled in the TNBC cohort of LEAP-005. Median age was 56 y (range, 37 to 85), 58% had received ≥2 prior lines of therapy, and 26% had CPS ≥10 tumors. As of the April 10, 2020 data cutoff, median follow-up was 7 mo (range, 4 to 13). ORR was 29% (95% CI: 14–48), with 1 CR and 8 PRs. 9 pts had SD, and the DCR (CR + PR + SD) was 58% (95% CI: 39–76). 4 responses (1 CR and 3 PRs) were in patients with CPS ≥10 tumors (n=8) for an ORR of 50% (95% CI: 16–84), and 5 responses (all PRs) were in patients with CPS <10 tumors (n=22) for an ORR of 23% (95% CI: 8–45). Median DOR was not reached (range, 0+ to 8+ mo); 7 (78%) responses were ongoing at data cutoff. Median PFS was 4 mo (95% CI: 2–NR), with a 6-mo rate of 49%. Treatment-related AEs (TRAEs) occurred in 97% of pts; 10% discontinued due to TRAEs. 55% of pts had grade 3-5 TRAEs (1 death due to subarachnoid hemorrhage). Conclusions: Lenvatinib in combination with pembrolizumab showed promising antitumor activity with manageable toxicity in patients with previously treated advanced TNBC. Based on these early data, the cohort will be expanded to include 100 patients.
Citation Format: Hyun Cheol Chung, Esma Saada-Bouzid, Federico Longo Muñoz, Eduardo Yanez, Seock-Ah Im, Eduardo Castanon, Donna M. Graham, Javier Garcia-Corbacho, Juanita Lopez, Razi Ghori, Corina Dutcus, Alan Smith, Kevin Norwood, Carlos Gomez-Roca. Lenvatinib plus pembrolizumab for previously treated, advanced triple-negative breast cancer: Early results from the multicohort phase 2 LEAP-005 study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS12-07.
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Affiliation(s)
- Hyun Cheol Chung
- 1Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, Republic of
| | | | | | - Eduardo Yanez
- 4Instituto Clinico Oncologico del Sur, Temuco, Chile
| | - Seock-Ah Im
- 5Seoul National University Hospital, Seoul, Korea, Republic of
| | | | - Donna M. Graham
- 7The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Juanita Lopez
- 9The Royal Marsden Foundation Trust and the Institute of Cancer Research, London, United Kingdom
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Taylor MH, Schmidt EV, Dutcus C, Pinheiro EM, Funahashi Y, Lubiniecki G, Rasco D. The LEAP program: lenvatinib plus pembrolizumab for the treatment of advanced solid tumors. Future Oncol 2021; 17:637-648. [DOI: 10.2217/fon-2020-0937] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Tumor progression and immune evasion result from multiple oncogenic and immunosuppressive signals within the tumor microenvironment. The combined blockade of VEGF and inhibitory immune checkpoint signaling has been shown to enhance immune activation and tumor destruction in preclinical models. The LEAP clinical trial program is evaluating the safety and efficacy of lenvatinib (a multikinase inhibitor) plus pembrolizumab (a PD-1 inhibitor) across several solid tumor types. Preliminary results from ongoing trials demonstrate robust antitumor activity and durable responses across diverse tumor types with a manageable safety profile. Thus, lenvatinib plus pembrolizumab is anticipated to be an important potential new regimen for several solid cancers that currently have limited therapeutic options. Clinical trial registration: NCT03884101 , NCT03713593 , NCT03820986 , NCT03776136 , NCT03797326 , NCT03829319 , NCT03829332 , NCT03976375 , NCT04428151 , NCT04199104 , NCT03898180 , NCT04246177 (ClinicalTrials.gov).
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Affiliation(s)
- Matthew H Taylor
- Earle A Chiles Research Institute, Providence Portland Medical Center, Portland, OR 97213, USA
| | - Emmett V Schmidt
- Department of Clinical Oncology, Merck & Co. Inc., Kenilworth, NJ 07033, USA
| | - Corina Dutcus
- Department of Clinical Research, Eisai Inc., Woodcliff Lake, NJ 07677, USA
| | - Elaine M Pinheiro
- Department of Clinical Oncology, Merck & Co. Inc., Kenilworth, NJ 07033, USA
| | - Yasuhiro Funahashi
- Biomarker Research Translational Science Department, Eisai Co., Ltd., Tokyo, 112-0002, Japan
| | - Gregory Lubiniecki
- Department of Clinical Oncology, Merck & Co. Inc., Kenilworth, NJ 07033, USA
| | - Drew Rasco
- The START Center for Cancer Care, San Antonio, TX 78229, USA
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9
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Brose M, Panaseykin Y, Konda B, Fouchardiere CDL, Hughes B, Gianoukakis A, Park Y, Romanov I, Krzyzanowska M, Binder T, Dutcus C, Xie R, Taylor M. 426P A multicenter, randomized, double-blind, phase II study of lenvatinib (LEN) in patients (pts) with radioiodine-refractory differentiated thyroid cancer (RR-DTC) to evaluate the safety and efficacy of a daily oral starting dose of 18 mg vs 24 mg. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.418] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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10
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Makker V, Rasco D, Vogelzang N, Brose M, Cohn A, Mier J, DiSimone C, Hyman D, Stepan D, Dutcus C, Schmidt E, Guo M, Sachdev P, Shumaker R, Aghajanian C, Taylor M. Lenvatinib plus pembrolizumab in patients with advanced endometrial cancer: Final analysis of a multicentre, open-label, single-arm, phase 2 trial. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Berry S, Giraldo N, Nguyen P, Green B, Xu H, Ogurtsova A, Soni A, Succaria F, Wang D, Roberts C, Stein J, Engle E, Pardoll D, Anders R, Cottrell T, Taube JM, Tran B, Voskoboynik M, Kuo J, Bang YL, Chung HC, Ahn MJ, Kim SW, Perera A, Freeman D, Achour I, Faggioni R, Xiao F, Ferte C, Lemech C, Meric-Bernstam F, Werner T, Hodi S, Messersmith W, Lewis N, Talluto C, Dostalek M, Tao A, McWhirter S, Trujillo D, Luke J, Xu C, BoMarelli, Qi J, Qin G, Yu H, Jenkins M, Lo KM, Halle JP, Lan Y, Taylor M, Vogelzang N, Cohn A, Stepan D, Shumaker R, Dutcus C, Guo M, Schmidt E, Rasco D, Brose M, Vogelzang N, Di Simone C, Jain S, Richards D, Encarnacion C, Rasco D, Shumaker R, Dutcus C, Stepan D, Guo M, Schmidt E, Taylor M, Vogelzang N, Encarnacion C, Cohn A, Di Simone C, Rasco D, Richards D, Taylor M, Dutcus C, Stepan D, Shumaker R, Guo M, Schmidt E, Mier J, An J, Yang YY, Lee WH, Yang J, Kim JK, Kim HG, Paek SH, Lee JW, Woo J, Kim JB, Kwon H, Lim W, Paik NS, Kim YK, Moon BI, Janku F, Tan D, Martin-Liberal J, Takahashi S, Geva R, Gucalp A, Chen X, Subramanian K, Mataraza J, Wheler J, Bedard P. Correction to: 33rd Annual Meeting & Pre-Conference Programs of the Society for Immunotherapy of Cancer (SITC 2018). J Immunother Cancer 2019; 7:46. [PMID: 30760319 PMCID: PMC6373015 DOI: 10.1186/s40425-019-0519-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sneha Berry
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Nicolas Giraldo
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter Nguyen
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Benjamin Green
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haiying Xu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Abha Soni
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Farah Succaria
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daphne Wang
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles Roberts
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie Stein
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth Engle
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Drew Pardoll
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert Anders
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tricia Cottrell
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Janis M Taube
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ben Tran
- Peter MacCallum Cancer Center, Melbourne, Australia
| | | | - James Kuo
- Scientia Clinical Research, Sydney, Australia
| | - Yung-Lue Bang
- Seoul National University Hospital, Seoul, Korea, Republic of
| | - Hyun-Cheo Chung
- Yonsei Cancer Center, Yonsei University, Seoul, Korea, Republic of
| | - Myung-Ju Ahn
- Samsung Medical Center, Seoul, Korea, Republic of
| | - Sang-We Kim
- Asan Medical Center, Songpa-Gu, Korea, Republic of
| | | | | | | | | | | | | | | | | | | | | | | | - Nancy Lewis
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Craig Talluto
- Novartis Institutes for BioMedical Resea, Cambridge, MA, USA
| | - Mirek Dostalek
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Aiyang Tao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | - Jason Luke
- The University of Chicago Medicine, Chicago, IL, USA
| | - Chunxiao Xu
- EMD Serono Research and Development, Belmont, MA, USA
| | - BoMarelli
- EMD Serono Research and Development, Belmont, MA, USA
| | - Jin Qi
- EMD Serono Research and Development, Belmont, MA, USA
| | - Guozhong Qin
- EMD Serono Research and Development, Belmont, MA, USA
| | - Huakui Yu
- EMD Serono Research and Development, Belmont, MA, USA
| | - Molly Jenkins
- EMD Serono Research and Development, Belmont, MA, USA
| | - Kin-Ming Lo
- EMD Serono Research and Development, Belmont, MA, USA
| | | | - Yan Lan
- EMD Serono Research and Development, Belmont, MA, USA.
| | - Matthew Taylor
- Oregon Health and Science University, Portland, OR, USA.
| | | | - Allen Cohn
- McKesson Specialty Health, Las Vegas, NV, USA
| | | | | | | | | | | | - Drew Rasco
- South Texas Accelerated Research Therape, San Antonio, TX, USA
| | - Marcia Brose
- Abramson Cancer Center of the University, Philadelphia, PA, USA.
| | | | | | - Sharad Jain
- McKesson Specialty Health, Las Vegas, NV, USA
| | | | | | - Drew Rasco
- South Texas Accelerated Research Therape, San Antonio, TX, USA
| | | | | | | | | | | | | | | | | | - Allen Cohn
- McKesson Specialty Health, Las Vegas, NV, USA
| | | | - Drew Rasco
- South Texas Accelerated Research Therape, San Antonio, TX, USA
| | | | | | | | | | | | | | | | - James Mier
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jeongshin An
- Ewha Womans University, Seoul, Korea, Republic of.
| | | | - Won-Hee Lee
- MD healthcare company, Seoul, Korea, Republic of
| | - Jinho Yang
- MD healthcare company, Seoul, Korea, Republic of
| | - Jong-Kyu Kim
- Ewha Womans University, Seoul, Korea, Republic of
| | - Hyun Goo Kim
- Ewha Womans University, Seoul, Korea, Republic of
| | - Se Hyun Paek
- Ewha Womans University, Seoul, Korea, Republic of
| | - Jun Woo Lee
- Ewha Womans University, Seoul, Korea, Republic of
| | - Joohyun Woo
- Ewha Womans University, Seoul, Korea, Republic of
| | - Jong Bin Kim
- Ewha Womans University, Seoul, Korea, Republic of
| | - Hyungju Kwon
- Ewha Womans University, Seoul, Korea, Republic of
| | - Woosung Lim
- Ewha Womans University, Seoul, Korea, Republic of
| | - Nam Sun Paik
- Ewha Womans University, Seoul, Korea, Republic of
| | | | | | - Filip Janku
- MD Anderson Cancer Center, Houston, TX, USA.
| | - David Tan
- National University Cancer Institute, Singapore, Singapore
| | | | | | - Ravit Geva
- Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ayca Gucalp
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Xueying Chen
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | - Jennifer Wheler
- Novartis Institutes for BioMedical Resea, Cambridge, MA, USA
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Kudo M, Finn RS, Qin S, Han KH, Ikeda K, Piscaglia F, Baron A, Park JW, Han G, Jassem J, Blanc JF, Vogel A, Komov D, Evans TRJ, Lopez C, Dutcus C, Guo M, Saito K, Kraljevic S, Tamai T, Ren M, Cheng AL. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomised phase 3 non-inferiority trial. Lancet 2018; 391:1163-1173. [PMID: 29433850 DOI: 10.1016/s0140-6736(18)30207-1] [Citation(s) in RCA: 3097] [Impact Index Per Article: 516.2] [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] [Received: 05/12/2017] [Revised: 08/31/2017] [Accepted: 09/28/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND In a phase 2 trial, lenvatinib, an inhibitor of VEGF receptors 1-3, FGF receptors 1-4, PDGF receptor α, RET, and KIT, showed activity in hepatocellular carcinoma. We aimed to compare overall survival in patients treated with lenvatinib versus sorafenib as a first-line treatment for unresectable hepatocellular carcinoma. METHODS This was an open-label, phase 3, multicentre, non-inferiority trial that recruited patients with unresectable hepatocellular carcinoma, who had not received treatment for advanced disease, at 154 sites in 20 countries throughout the Asia-Pacific, European, and North American regions. Patients were randomly assigned (1:1) via an interactive voice-web response system-with region; macroscopic portal vein invasion, extrahepatic spread, or both; Eastern Cooperative Oncology Group performance status; and bodyweight as stratification factors-to receive oral lenvatinib (12 mg/day for bodyweight ≥60 kg or 8 mg/day for bodyweight <60 kg) or sorafenib 400 mg twice-daily in 28-day cycles. The primary endpoint was overall survival, measured from the date of randomisation until the date of death from any cause. The efficacy analysis followed the intention-to-treat principle, and only patients who received treatment were included in the safety analysis. The non-inferiority margin was set at 1·08. The trial is registered with ClinicalTrials.gov, number NCT01761266. FINDINGS Between March 1, 2013 and July 30, 2015, 1492 patients were recruited. 954 eligible patients were randomly assigned to lenvatinib (n=478) or sorafenib (n=476). Median survival time for lenvatinib of 13·6 months (95% CI 12·1-14·9) was non-inferior to sorafenib (12·3 months, 10·4-13·9; hazard ratio 0·92, 95% CI 0·79-1·06), meeting criteria for non-inferiority. The most common any-grade adverse events were hypertension (201 [42%]), diarrhoea (184 [39%]), decreased appetite (162 [34%]), and decreased weight (147 [31%]) for lenvatinib, and palmar-plantar erythrodysaesthesia (249 [52%]), diarrhoea (220 [46%]), hypertension (144 [30%]), and decreased appetite (127 [27%]) for sorafenib. INTERPRETATION Lenvatinib was non-inferior to sorafenib in overall survival in untreated advanced hepatocellular carcinoma. The safety and tolerability profiles of lenvatinib were consistent with those previously observed. FUNDING Eisai Inc.
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Affiliation(s)
- Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan.
| | - Richard S Finn
- Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Shukui Qin
- Nanjing Bayi Hospital, Nanjing, Jiangsu, China
| | - Kwang-Hyub Han
- Severance Hospital, Yonsei University, Seoul, South Korea
| | | | | | - Ari Baron
- California Pacific Medical Center, San Francisco, CA, USA
| | | | - Guohong Han
- Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | | | | | | | - Dmitry Komov
- N N Blokhin Cancer Research Center, Moscow, Russia
| | - T R Jeffry Evans
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Carlos Lopez
- Marqués de Valdecilla University Hospital, Santander, Spain
| | | | | | | | | | | | - Min Ren
- Eisai, Woodcliff Lake, NJ, USA
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13
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Finn R, Kudo M, Cheng AL, Wyrwicz L, Ngan R, Blanc JF, Baron A, Vogel A, Ikeda M, Piscaglia F, Han KH, Qin S, Minoshima Y, Funahashi Y, Ren M, Dairiki R, Sachdev P, Tamai T, Dutcus C, Evans T. Analysis of serum biomarkers (BM) in patients (pts) from a phase 3 study of lenvatinib (LEN) vs sorafenib (SOR) as first-line treatment for unresectable hepatocellular carcinoma (uHCC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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14
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Ikeda M, Sasaki T, Morizane C, Mizuno N, Nagashima F, Shimizu S, Hayata N, Ikezawa H, Suzuki T, Nakajima R, Dutcus C, Ueno M. A phase 2 study of lenvatinib monotherapy as second-line treatment in unresectable biliary tract cancer: Primary analysis results. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.106] [Citation(s) in RCA: 7] [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: 11/13/2022] Open
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15
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Tahara M, Brose M, Wirth L, Suzuki T, Fujino K, Batty N, Dutcus C, Gianoukakis A. Impact of duration of dose interruption on the efficacy of lenvatinib (LEN) in a phase 3 sudy in patients (pts) with radioiodine refractory differentiated thyroid cancer (RR-DTC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx368.007] [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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Lee CH, Makker V, Rasco D, Taylor M, Dutcus C, Shumaker R, Schmidt E, Stepan D, Li D, Motzer R. A phase 1b/2 trial of lenvatinib plus pembrolizumab in patients with renal cell carcinoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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17
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Vogel A, Qin S, Kudo M, Hudgens S, Yamashita T, Yoon JH, Fartoux L, Simon K, López López C, Sung M, Dutcus C, Kraljevic S, Tamai T, Grunow N, Meier G, Breder V. Health-related quality of Life (HRQOL) and disease symptoms in patients with unresectable hepatocellular carcinoma (HCC) treated with lenvatinib (LEN) or sorafenib (SOR). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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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Gianoukakis AG, Mathias EG, Dutcus C, Kalantari P, Yoon S. Response to lenvatinib treatment in patients with radioiodine-refractory differentiated thyroid cancer (RR-DTC): Updated results from SELECT. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.6089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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)
| | | | | | - Parmida Kalantari
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Steve Yoon
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
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Takahashi S, Kiyota N, Yamazaki T, Chayahara N, Nakano K, INAGAKI LINA, Toda K, Enokida T, Minami H, Imamura Y, Sasaki T, Suzuki T, Fujino K, Dutcus C, Tahara M. Phase II study of lenvatinib in patients with differentiated, medullary, and anaplastic thyroid cancer: Final analysis results. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.6088] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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)
- Shunji Takahashi
- Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan
| | - Tomoko Yamazaki
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Naoko Chayahara
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan
| | - Kenji Nakano
- Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - LINA INAGAKI
- Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kazuhisa Toda
- Department of Head and Neck Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomohiro Enokida
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hironobu Minami
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan
| | - Yoshinori Imamura
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan
| | | | | | | | | | - Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
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Motzer RJ, Hutson TE, Ren M, Dutcus C, Larkin J. Independent assessment of lenvatinib plus everolimus in patients with metastatic renal cell carcinoma. Lancet Oncol 2015; 17:e4-5. [PMID: 26758760 DOI: 10.1016/s1470-2045(15)00543-4] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 11/17/2015] [Accepted: 11/18/2015] [Indexed: 01/08/2023]
Affiliation(s)
- Robert J Motzer
- Memorial Sloan-Kettering Cancer Center, New York, NY, 10021, USA.
| | | | - Min Ren
- Eisai Inc, Woodcliff Lake, NJ, USA
| | | | - James Larkin
- Royal Marsden Hospital NHS Foundation Trust, London, UK
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Motzer RJ, Hutson TE, Glen H, Michaelson MD, Molina A, Eisen T, Jassem J, Zolnierek J, Maroto JP, Mellado B, Melichar B, Tomasek J, Kremer A, Kim HJ, Wood K, Dutcus C, Larkin J. Lenvatinib, everolimus, and the combination in patients with metastatic renal cell carcinoma: a randomised, phase 2, open-label, multicentre trial. Lancet Oncol 2015; 16:1473-1482. [PMID: 26482279 DOI: 10.1016/s1470-2045(15)00290-9] [Citation(s) in RCA: 631] [Impact Index Per Article: 70.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 08/26/2015] [Accepted: 08/27/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Currently, metastatic renal cell carcinoma is treated with sequential single agents targeting VEGF or mTOR. Here, we aimed to assess lenvatinib, everolimus, or their combination as second-line treatment in patients with metastatic renal cell carcinoma. METHODS We did a randomised, phase 2, open-label, multicentre trial at 37 centres in five countries and enrolled patients with advanced or metastatic, clear-cell, renal cell carcinoma. We included patients who had received treatment with a VEGF-targeted therapy and progressed on or within 9 months of stopping that agent. Patients were randomised via an interactive voice response system in a 1:1:1 ratio to either lenvatinib (24 mg/day), everolimus (10 mg/day), or lenvatinib plus everolimus (18 mg/day and 5 mg/day, respectively) administered orally in continuous 28-day cycles until disease progression or unacceptable toxic effects. The randomisation procedure dynamically minimised imbalances between treatment groups for the stratification factors haemoglobin and corrected serum calcium. The primary objective was progression-free survival in the intention-to-treat population. This study is closed to enrolment but patients' treatment and follow-up is ongoing. This study is registered with ClinicalTrials.gov, number NCT01136733. FINDINGS Between March 16, 2012, and June 19, 2013, 153 patients were randomly allocated to receive either the combination of lenvatinib plus everolimus (n=51), single-agent lenvatinib (n=52), or single-agent everolimus (n=50). Lenvatinib plus everolimus significantly prolonged progression-free survival compared with everolimus alone (median 14·6 months [95% CI 5·9-20·1] vs 5·5 months [3·5-7·1]; hazard ratio [HR] 0·40, 95% CI 0·24-0·68; p=0·0005), but not compared with lenvatinib alone (7·4 months [95% CI 5·6-10·2]; HR 0·66, 95% CI 0·30-1·10; p=0·12). Single-agent lenvatinib significantly prolonged progression-free survival compared with everolimus alone (HR 0·61, 95% CI 0·38-0·98; p=0·048). Grade 3 and 4 events occurred in fewer patients allocated single-agent everolimus (25 [50%]) compared with those assigned lenvatinib alone (41 [79%]) or lenvatinib plus everolimus (36 [71%]). The most common grade 3 or 4 treatment-emergent adverse event in patients allocated lenvatinib plus everolimus was diarrhoea (ten [20%]), in those assigned single-agent lenvatinib it was proteinuria (ten [19%]), and in those assigned single-agent everolimus it was anaemia (six [12%]). Two deaths were deemed related to study drug, one cerebral haemorrhage in the lenvatinib plus everolimus group and one myocardial infarction with single-agent lenvatinib. INTERPRETATION Lenvatinib plus everolimus and lenvatinib alone resulted in a progression-free survival benefit for patients with metastatic renal cell carcinoma who have progressed after one previous VEGF-targeted therapy. Further study of lenvatinib is warranted in patients with metastatic renal cell carcinoma. FUNDING Eisai Inc.
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Affiliation(s)
| | | | - Hilary Glen
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Ana Molina
- Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Timothy Eisen
- Addenbrooke's Hospital, Cambridge Biomedical Research Centre, Cambridge, UK
| | | | | | | | - Begoña Mellado
- Medical Oncology Department, Translational Genomics and Targeted Therapeutics in Solid Tumors Group, IDIBAPS, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Bohuslav Melichar
- Onkologicka klinika, Lekarska fakulta Univerzity Palackeho a Fakultni nemocnice, Olomouc, Czech Republic
| | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Masaryk University, Brno, Czech Republic
| | | | | | | | | | - James Larkin
- Royal Marsden Hospital NHS Foundation Trust, London, UK
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22
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Kiyota N, Robinson B, Shah M, Hoff A, Taylor M, Li D, Dutcus C, Lee E, Kim S, Tahara M. 2864 Defining 131I-refractory differentiated thyroid cancer: efficacy and safety of lenvatinib by 131I-refractory criteria in the SELECT trial. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31602-1] [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: 11/15/2022]
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Brose MS, Schlumberger M, Tahara M, Wirth LJ, Robinson B, Elisei R, Newbold K, Kiyota N, Hoff AO, Dutcus C, Song J, Sherman SI, Taylor MH. Effect of age and lenvatinib treatment on overall survival for patients with 131I-refractory differentiated thyroid cancer in SELECT. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.6048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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)
- Marcia S. Brose
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and University Paris-Sud, Villejuif, France
| | - Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | | | - Bruce Robinson
- Kolling Institute of Medical Research, The University of Sydney, New South Wales, Australia
| | - Rossella Elisei
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Kate Newbold
- Royal Marsden Hospital National Health Service Trust, London, United Kingdom
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan
| | - Ana O. Hoff
- Department of Endocrinology, Instituto do Cancer do Estado de Sao Paulo,Universidade de Sao Paulo, São Paulo, Brazil
| | | | | | - Steven I. Sherman
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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Tahara M, Schlumberger M, Elisei R, Habra MA, Kiyota N, Dutcus C, Xu J, Zhu J, Hihara T, McGrath S, Matijevic M, Kadowaki T, Funahashi Y, Sherman SI. Pharmacodynamic biomarkers of outcomes in the phase III study of lenvatinib in 131I-refractory differentiated thyroid cancer (SELECT). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.6014] [Citation(s) in RCA: 2] [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: 11/20/2022] Open
Affiliation(s)
- Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and University Paris-Sud, Villejuif, France
| | - Rossella Elisei
- Department of Endocrinology, University of Pisa, Pisa, Italy
| | - Mouhammed Amir Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naomi Kiyota
- Division of Medical Oncology / Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
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Newbold K, Elisei R, Taylor MH, Krzyzanowska MK, Shah MH, Hoff AO, Robinson B, Dutcus C, Song J, Habra MA. Efficacy and safety of lenvatinib for the treatment of patients with 131I-refractory differentiated thyroid cancer with and without prior VEGF-targeted therapy. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.6013] [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)
- Kate Newbold
- Royal Marsden Hospital National Health Service Trust, London, United Kingdom
| | - Rossella Elisei
- Department of Endocrinology, University of Pisa, Pisa, Italy
| | | | - Monika K. Krzyzanowska
- Division of Medical Oncology & Haematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Manisha H. Shah
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Ana O. Hoff
- Department of Endocrinology, Instituto do Cancer do Estado de Sao Paulo,Universidade de Sao Paulo, São Paulo, Brazil
| | - Bruce Robinson
- Kolling Institute of Medical Research, The University of Sydney, New South Wales, Australia
| | | | | | - Mouhammed Amir Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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Motzer R, Hutson T, Glen H, Michaelson D, Molina AM, Eisen T, Jassem J, Zolnierek J, Maroto P, Mellado B, Melichar B, Tomasek J, Kim HJ, Wood K, Dutcus C, Larkin JMG. Randomized phase II, three-arm trial of lenvatinib (LEN), everolimus (EVE), and LEN+EVE in patients (pts) with metastatic renal cell carcinoma (mRCC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.4506] [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)
- Robert Motzer
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Thomas Hutson
- Texas Oncology–Baylor Charles A. Sammons Cancer Center, Dallas, TX
| | - Hilary Glen
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | - Ana M. Molina
- Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY
| | | | | | | | - Pablo Maroto
- Departamento de Oncología Médica, Barcelona, Spain
| | - Begona Mellado
- Translational Genomics and Targeted Therapeutics in Oncology.IDIBAPS. Medical Oncology Department. Hospital Clinic, Barcelona, Spain
| | - Bohuslav Melichar
- Onkologicka Klinika, Lekarska Fakulta Univerzity Palackeho a Fakultni Nemocnice, Olomouc, Czech Republic
| | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Masaryk University, Brno, Czech Republic
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Wirth L, Tahara M, Robinson B, Francis S, Brose M, Habra M, Newbold K, Kiyota N, Dutcus C, Heras B, Zhu J, Sherman S, Schlumberger M. Treatment-Emergent Hypertension and Efficacy in the Phase 3 Study of (E7080) Lenvatinib in Differentiated Cancer of the Thyroid (Select). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu340.45] [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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Takahashi S, Tahara M, Kiyota N, Yamazaki T, Chayahara N, Nakano K, Inagaki R, Toda K, Enokida T, Minami H, Imamura Y, Sasaki T, Suzuki T, Fujino K, Dutcus C. Phase Ii Study of Lenvatinib (Len), a Multi-Targeted Tyrosine Kinase Inhibitor, in Patients (Pts) with All Histologic Subtypes of Advanced Thyroid Cancer (Differentiated, Medullary and Anaplastic). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu340.10] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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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Robinson B, Schlumberger M, Wirth L, Dutcus C, Heras B, Zhu J, Taylor M, Kim S., Krzyzanowska M, Capdevila J, Sherman S, Tahara M. Characterization of Tumor Size Changes Over Time from the Phase 3 Study of (E7080) Lenvatinib in Differentiated Cancer of the Thyroid (Select). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu340.46] [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: 11/14/2022] Open
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Elisei R, Schlumberger M, Tahara M, Robinson B, Brose M, Dutcus C, Heras B, Zhu J, Habra M, Newbold K, Shah M, Hoff A, Gianoukakis A, Kiyota N, Taylor M, Kim S, Krzyzanowska M, Sherman S, Wirth L. Subgroup Analyses of a Phase 3, Multicenter, Double-Blind, Placebo-Controlled Trial of Lenvatinib (E7080) in Patients with 131I-Refractory Differentiated Thyroid Cancer. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu340.48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tahara M, Schlumberger M, Wirth L, Elisei R, Brose M, Habra M, Newbold K, Kiyota N, Dutcus C, Zhu J, Kadowaki T, Funahashi Y, Robinson B, Sherman S. Comprehensive Analysis of Serum Biomarker and Tumor Gene Mutation Associated with Clinical Outcomes in the Phase 3 Study of (E7080) Lenvatinib in Differentiated Cancer of the Thyroid (Select). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Twelves C, Awada A, Kaufman PA, Yelle L, Perez EA, Velikova G, Wanders J, Olivo MS, He Y, Dutcus C, Simons WR, Cortes J. Quality of life (QoL) and content validity in objective tumor response. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.1055] [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
1055^ Background: Key properties of QoL instruments in a clinical trial setting are reliability, the ability to detect a change, and content validity. Using data from the Study 301 phase III breast cancer trial, we report here content validity and ability to detect a change for the EORTC QLQ-C30 and breast cancer-specific QLQ-BR23 questionnaires. Methods: Patients with locally advanced or metastatic breast cancer were randomized to 21-day cycles of either eribulin mesylate 1.4 mg/m2 given on Days 1 and 8, or capecitabine 1.25 g/m2BID orally on Days 1-14. QoL questionnaires were completed at baseline and at 6 weeks, 3, 6, 12, 18, and 24 months. Objective tumor response was evaluated (complete response [CR]; partial response [PR]; stable disease [SD]; progressive disease [PD]). Univariate and multivariate longitudinal analyses using weighted generalized estimating equations were employed to assess the responsiveness of the QoL scales to objective tumor response. Results: 1,102 patients were randomized (554 eribulin, 548 capecitabine). Global health status (GHS)/QoL scores were low at baseline (55). GHS/QoL scores were highest for patients with CR (70.8), followed by those patients with PR (63.5), SD (60.5), and PD (58.1). Physical functioning followed the same pattern: CR (98.3); PR (79.1); SD (72.8); PD (71.0). Role and social functioning scores were also responsive. Pain increased, while fatigue and body image worsened, with poorer tumor responses. Using the weighted generalized estimating equations, there were improvements in physical (34.78; p<0.01), cognitive (27.29; p<0.01), and social (22.04; p<0.01) functioning, and future perspective 11.47 (p<0.01), in patients who responded (CR and PR) to treatment compared with non-responders. Pain decreased significantly by 28.62 (p<0.01) on a 0-100 scale. Patients who responded also gained appetite and had fewer breast symptoms. Conclusions: These results suggest content validity of the EORTC QLQ-30 and QLQ-BR23 questionnaires as they correlate with changes in objective tumor assessments. Clinical trial information: NCT00337103.
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Affiliation(s)
- Christopher Twelves
- Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom
| | - Ahmad Awada
- Medical Oncology Clinic, Jules Bordet Institute, Brussels, Belgium
| | | | | | | | - Galina Velikova
- Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom
| | | | | | - Yi He
- Eisai Inc., Woodcliff Lake, NJ
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Kaufman PA, Cortes J, Awada A, Yelle L, Perez EA, Wanders J, Olivo MS, He Y, Dutcus C, Twelves C. A phase III, open-label, randomized study of eribulin mesylate versus capecitabine in patients with locally advanced or metastatic breast cancer (MBC) previously treated with anthracyclines and taxanes: Subgroup analyses. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.1049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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
1049^ Background: This phase III study, comparing eribulin versus capecitabine, showed a non-significant trend for superior overall survival (OS; hazard ratio [HR] 0.88 [95% confidence interval (CI) 0.77, 1.00]; p = 0.056) but not progression-free survival (PFS; HR 1.08 [95% CI 0.93, 1.25]; p = 0.31). Pre-specified exploratory subgroup analyses previously presented showed that patients with triple-negative, ER-negative or HER2-negative disease may have a greater benefit in OS with eribulin compared with capecitabine. Here we present further pre-specified exploratory analyses of OS and PFS. Methods: Patients (eribulin n=554; capecitabine n=548) with locally advanced or MBC had received ≤3 prior chemotherapy regimens (≤2 for advanced disease), including an anthracycline and a taxane. Patients were randomized (stratified for geographic region and HER2 status) 1:1 to 21-day cycles of eribulin mesylate 1.4 mg/m2 i.v. on days 1 and 8 or capecitabine 1.25 g/m2BID orally on days 1-14. Further pre-specified exploratory subgroups included: age; receptor status; number and setting of prior chemotherapy regimen(s); sites of disease; number of organs involved; and time to progression after last chemotherapy. Results: From analyses for OS, patients with only non-visceral disease (HR 0.51; 95% CI 0.33, 0.80), with >2 organs involved (HR 0.75; 95% CI 0.62, 0.90), who had progressed >6 months after last chemotherapy (HR 0.70; 95% CI 0.52, 0.95), or who had received an anthracycline and/or a taxane in the metastatic setting (HR 0.84; 95% CI 0.72, 0.98), appeared to benefit more from treatment with eribulin compared with capecitabine. For OS, in no subgroup was a trend favoring capecitabine seen. Data for other pre-specified subgroups for both OS and PFS will be presented. Conclusions: In addition to patients with triple-, ER-, or HER2-negative disease, further pre-specified exploratory analyses suggest that other patient subgroups may particularly benefit from treatment with eribulin; further studies are warranted to address these hypotheses. Clinical trial information: NCT00337103.
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Affiliation(s)
| | | | - Ahmad Awada
- Medical Oncology Clinic, Jules Bordet Institute, Brussels, Belgium
| | | | | | | | | | - Yi He
- Eisai Inc., Woodcliff Lake, NJ
| | | | - Christopher Twelves
- Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom
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Cortes J, Awada A, Kaufman PA, Yelle L, Perez EA, Velikova G, Wanders J, Olivo MS, He Y, Dutcus C, Simons WR, Twelves C. Quality of life (QoL) in patients (pts) with locally advanced or metastatic breast cancer (MBC) previously treated with anthracyclines and taxanes who received eribulin mesylate or capecitabine: A phase III, open-label, randomized study. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.1050] [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: 11/20/2022] Open
Abstract
1050^ Background: In a phase III trial comparing eribulin (E) vs. capecitabine (C) in pts with locally advanced or MBC, a trend for improved OS was observed but a statistically significant superiority was not demonstrated with E vs. C for OS or PFS. The AE profiles were consistent with known side effects. We now report QoL results from this trial. Methods: Pts received eribulin mesylate 1.4 mg/m2 on Days 1 and 8, or C 1.25 g/m2 BID orally on Days 1-14, of a 21-day cycle. Eligible pts had received prior therapy including an anthracycline and taxane, and were receiving study drug as 1st-, 2nd-, or 3rd-line therapy for advanced disease. QoL, a secondary objective, was assessed using EORTC QLQ-C30 and QLQ-BR23 questionnaires at baseline, 6 weeks, 3, 6, 12, 18, and 24 months after starting treatment (or until progressive disease or treatment change), and at unscheduled visits. Longitudinal analyses were carried out using weighted generalized estimating equations adjusted for non-random attrition due to death within 12 months. Model covariates were time (visit), region, and baseline QoL. The primary endpoint was change from baseline for Global Health Status (GHS)/overall QoL; exploratory endpoints were change from baseline for each functional domain, and signs/symptoms. Results: 1,102 pts were randomized (E 554; C 548). GHS/QoL scores were low at baseline for E (56.3) and C (54.7) on a scale of 0 (worse) to 100 (best). GHS/QoL and cognitive functioning improved significantly more in pts receiving E vs. C, (6.5 [p=0.048] and 15.3 [p<0.001], respectively). Emotional functioning improved significantly for pts receiving C vs. E (3.3; p=0.033). Pain was comparable at baseline, and was lower at subsequent visits with both treatments. Patient-reported signs/symptoms in favor of E included nausea and vomiting (E1.9; p=0.043) and diarrhea (-3.7; p=0.001); systemic side effects (5.2; p<0.001) and upset by hair loss (9.3; p=0.023) favored C. Conclusions: GHS/QoL scores improved more in pts receiving E than C. E showed advantages in terms of gastrointestinal effects while C had advantages in relation to hair loss. Clinical trial information: NCT00337103.
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Affiliation(s)
| | - Ahmad Awada
- Medical Oncology Clinic, Jules Bordet Institute, Brussels, Belgium
| | | | | | | | - Galina Velikova
- Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom
| | | | | | - Yi He
- Eisai Inc., Woodcliff Lake, NJ
| | | | | | - Christopher Twelves
- Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom
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Cortes J, Twelves C, Wanders J, Wang W, Vahdat L, Dutcus C. Clinical response to eribulin in patients with metastatic breast cancer is independent of time to first metastatic event. EMBRACE study group. Breast 2011. [DOI: 10.1016/j.breast.2011.08.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Vahdat LT, Cortes J, Twelves C, Wanders J, Seegobin S, Dutcus C, O'Shaughnessy J. Impact of eribulin on overall survival in patients with metastatic breast cancer with visceral disease. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.27_suppl.239] [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
239 Background: Visceral disease is associated with poor survival outcome in women with metastatic breast cancer (mBC). Eribulin mesylate is a nontaxane microtubule dynamics inhibitor indicated for 3rd-line monotherapy in patients (pts) with mBC previously treated with at least two chemotherapeutic regimens in the metastatic setting, including an anthracycline and a taxane. Methods: Evidence from the global, randomized, multicenter, phase III clinical trial of eribulin in mBC (EMBRACE) demonstrated improved overall survival (OS) for eribulin-treated pts when compared to treatment of physician’s choice (TPC). In this unplanned subgroup analysis, we compare the clinical benefit of eribulin to TPC in mBC pts with visceral disease using the Independent Review database. Patients were categorized as having visceral disease if they had target or non-target lesion involvement in the adrenal gland, liver, lung, pleural, pericardial/peritoneal cavity, spleen, or thyroid. Patients with brain metastases were excluded from the trial. Results: EMBRACE enrolled 762 pts with mBC, with single organ disease present in 120 pts (15.7%). The remaining pts had multi-organ disease. A total of 81.9% (624) of pts were classified as having visceral disease–81.3% (413) randomized to receive eribulin and 83.1% (211) to receive TPC. Metastatic tumor site was similar in eribulin and TPC arms, with liver (58.3%; 62.6%), lung (38.8%; 37.4%) and pleural (17.1%; 16.5%) involvement. Patients with visceral disease treated with eribulin demonstrated a significant benefit in OS compared to TPC (HR 0.77, p=0.02). Median OS in mBC pts with visceral disease was 12.45 months (mos) for eribulin-treated pts, with ORR=11.0% and CBR*=21.7% compared to OS=10.12 mos, ORR=5.0%, CBR*=16.6% for TPC-treated patients (*CBR defined as CR+PR+SD>6mos). No significant treatment difference was observed in the non-visceral disease patients however due to the small number of patients with non-visceral disease, no robust statistical conclusions can be made. Conclusions: Treatment with eribulin resulted in significant improvement in overall survival for mBC pts with visceral disease compared to other commonly used chemotherapeutic agents.
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Affiliation(s)
- L. T. Vahdat
- Weill Cornell Medical College, New York, NY; Vall d'Hebron University Hospital, Barcelona, Spain; University of Leeds and St. James's University Hospital, Leeds, United Kingdom; Eisai, Hatfield, United Kingdom; Eisai Inc., Woodcliff Lake, NJ; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX
| | - J. Cortes
- Weill Cornell Medical College, New York, NY; Vall d'Hebron University Hospital, Barcelona, Spain; University of Leeds and St. James's University Hospital, Leeds, United Kingdom; Eisai, Hatfield, United Kingdom; Eisai Inc., Woodcliff Lake, NJ; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX
| | - C. Twelves
- Weill Cornell Medical College, New York, NY; Vall d'Hebron University Hospital, Barcelona, Spain; University of Leeds and St. James's University Hospital, Leeds, United Kingdom; Eisai, Hatfield, United Kingdom; Eisai Inc., Woodcliff Lake, NJ; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX
| | - J. Wanders
- Weill Cornell Medical College, New York, NY; Vall d'Hebron University Hospital, Barcelona, Spain; University of Leeds and St. James's University Hospital, Leeds, United Kingdom; Eisai, Hatfield, United Kingdom; Eisai Inc., Woodcliff Lake, NJ; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX
| | - S. Seegobin
- Weill Cornell Medical College, New York, NY; Vall d'Hebron University Hospital, Barcelona, Spain; University of Leeds and St. James's University Hospital, Leeds, United Kingdom; Eisai, Hatfield, United Kingdom; Eisai Inc., Woodcliff Lake, NJ; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX
| | - C. Dutcus
- Weill Cornell Medical College, New York, NY; Vall d'Hebron University Hospital, Barcelona, Spain; University of Leeds and St. James's University Hospital, Leeds, United Kingdom; Eisai, Hatfield, United Kingdom; Eisai Inc., Woodcliff Lake, NJ; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX
| | - J. O'Shaughnessy
- Weill Cornell Medical College, New York, NY; Vall d'Hebron University Hospital, Barcelona, Spain; University of Leeds and St. James's University Hospital, Leeds, United Kingdom; Eisai, Hatfield, United Kingdom; Eisai Inc., Woodcliff Lake, NJ; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX
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Cardoso F, Twelves C, Vahdat L, Dutcus C, Seegobin S, Wanders J, Cortes J, O'Shaughnessy J. 5006 ORAL Eribulin Mesylate EMBRACE Study – Survival Analysis Excluding Patients Re-challenged With Therapies of the Same Class. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71448-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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