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Roth P, Gorlia T, Reijneveld JC, De Vos FYFL, Idbaih A, Frenel JS, Le Rhun E, Sepulveda Sánchez JM, Perry JR, Masucci L, Freres P, Hirte HW, Seidel C, Walenkamp AME, Dhermain F, Van Den Bent MJ, O'Callaghan CJ, Vanlancker M, Mason WP, Weller M. EORTC 1709/CCTG CE.8: A phase III trial of marizomib in combination with temozolomide-based radiochemotherapy versus temozolomide-based radiochemotherapy alone in patients with newly diagnosed glioblastoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.2004] [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
2004 Background: Patients with newly diagnosed glioblastoma receive postoperative standard therapy with radiotherapy (RT), and concomitant and up to six cycles of maintenance temozolomide (TMZ) chemotherapy (TMZ/RT→TMZ). Marizomib is a novel, irreversible and brain-penetrant pan-proteasome inhibitor with encouraging findings in preclinical models and early-stage clinical trials for patients with newly diagnosed and recurrent glioblastoma. Therefore, a phase 3 trial was designed to explore the activity of marizomib in addition to TMZ/RT→TMZ. ClinicalTrials.gov Identifier: NCT03345095 Methods: EORTC 1709/CCTG CE.8 is a multicenter, randomized, controlled, open label phase 3 superiority trial. Eligibility criteria included histologically confirmed newly diagnosed glioblastoma and a Karnofsky performance status (KPS) > 70. Eligible patients were stratified for institution, age, KPS as well as extent of surgery, and centrally randomized in a 1:1 ratio. The primary objective of this study is to compare overall survival (OS) in patients receiving marizomib in addition to standard treatment with patients receiving standard treatment only. Secondary endpoints include progression-free survival (PFS), safety, neurocognitive function, and quality of life. Results: The study was opened at 49 EORTC sites in Europe, 23 CCTG sites in Canada, and 8 sites in the US. Patient enrolment started in June 2018 and was close to completion at the time of a planned interim analysis in September 2020. A total of 749 patients (of the planned 750) were randomized when the IDMC recommended to discontinue enrollment. Age, KPS and extent of resection were well balanced between the 2 study arms. No difference in median OS was observed between the standard arm (15.9 months) and the marizomib arm (15.7 months; HR = 0.99). Median PFS was 6.1 vs. 6.2 months (HR = 1.02). Patients in the marizomib group had more often grade 3/4 treatment-emergent adverse events (TEAE) compared to the standard therapy group (42.6% vs. 20.5%), including ataxia, hallucinations and headache. Conclusions: The addition of marizomib to standard radiochemotherapy did not improve OS or PFS in patients with newly diagnosed glioblastoma. Final survival analyses including determination of MGMT promoter methylation status and analyses of other secondary endpoints are ongoing. Clinical trial information: NCT03345095.
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Affiliation(s)
- Patrick Roth
- Department of Neurology, University Hospital Zürich, Zürich, Switzerland
| | | | - Jaap C. Reijneveld
- Department of Neurology, VU University Medical Center, Amsterdam, Netherlands
| | | | - Ahmed Idbaih
- Inserm U 1127, Cnrs Umr 7225, Sorbonne Universités, UPMC Univ Paris 06 Umr S 1127, Institut Du Cerveau Et De La Moelle Épinière, ICM, Paris, France
| | - Jean-Sebastien Frenel
- GINECO & Institut de Cancerologie de l'Ouest, Centre René Gauducheau, Saint-Herblain, France
| | | | | | | | | | | | - Hal W. Hirte
- McMaster University Juravinski Cancer Centre, Hamilton, ON, Canada
| | | | | | | | | | | | | | - Warren P. Mason
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Michael Weller
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, and Neuroscience Center Zürich, University Hospital and University of Zürich, Zürich, Switzerland
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Wick W, Wick A, Chinot OL, Van Den Bent MJ, De Vos FYFL, Mansour M, Podola L, Lubenau H, Platten M. Oral DNA vaccination targeting VEGFR2 combined with anti-PDL1 avelumab in patients with progressive glioblastoma: Safety run-in results—NCT03750071. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.3001] [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
3001 Background: VEGFR2 overexpression in glioblastoma serves as a target for VEGFR2 primed T cells using VXM01 DNA vaccine encoding for VEGFR2. VXM01 is delivered in a bacterial Ty21a carrier suitable for oral administration. A previous phase I/II study in 14 patients with progressive glioblastoma showed that detection of VEGFR2 specific T cells as well as altered intra-tumoral immunity is correlated with prolonged overall survival, one partial response was reported with VXM01 alone. Three patients received nivolumab in addition to VXM01, which resulted in one complete and one partial clinical response. Based on these findings, a trial combining VXM01 and avelumab was designed. Methods: A multicentre, open-label phase I/II study ( EudraCT 2017-003076-31) in progressive glioblastoma includes 30 patients (24 non-resectable, 6 resectable) previously treated with temozolomide/radiotherapy. VXM01 is administered on day 1, 3, 5, 7 followed by boostings q4w. Avelumab 800mg is given intravenously q2w. Treatment continues up to week 48 followed by a 2 year observation period. The safety run-in phase of dose groups treated with VXM01 106 or 107 CFU plus avelumab was completed with 9 patients. Safety evaluation by the Data Safety Monitoring Board was performed after 3 and 9 patients treated for at least 5 weeks. Endpoints include safety and tolerability, objective response rate (ORR), clinical response using immune-response assessment in Neurooncology criteria (iRANO), and immunological assays like ELISpot, FACS, TCR-sequencing and tumor stainings. Results: No treatment-related toxicities were observed. Three partial responses with tumor reductions of 58, 81 and 95% to baseline were reported in 9 patients according to iRANO. Two of these patients are progression-free > 6 months. Significant VEGFR2 specific T cell responses were measured in several patients, and pre-existing intra-tumoral T cells are positively associated with the effectiveness of the immunotherapy combination. Conclusions: VXM01 in combination with avelumab was safe and produces detectable peripheral VEGFR-2 specific immune responses. Three patients had an objective response. Clinical trial information: NCT03750071 .
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Affiliation(s)
- Wolfgang Wick
- National Center for Tumor Diseases (NCT), UKHD and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Antje Wick
- Neurology Clinic, University of Heidelberg, National Center for Tumor Diseases, Heidelberg, Germany
| | - Olivier L. Chinot
- Aix-Marseille University, AP-HM, Service de Neuro-Oncologie, CHU Timone, Marseille, France
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van Berge Henegouwen JM, Hoes LR, van der Wijngaart H, Van Der Velden DL, Huitema A, Cuppen EP, Lugtenburg EJ, De Vos FYFL, Bloemendal H, Grunberg K, Verheul HM, Gelderblom H, Voest EE. Update on the Drug Rediscovery Protocol: Expanded use of existing anticancer drugs in patients with a known molecular profile. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.tps3149] [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
TPS3149 Background: With the emergence of large-scale genetic tumor profiling and the increasing availability of approved targeted therapies, precision medicine has become crucial in cancer treatment. However, for many cancers the relative contribution of either tumor type or genetic aberration to drug sensitivity often remains unknown. Since drug access is generally limited to the on-label indication and outcome of off-label use is not systematically collected in clinical practice, innovative trials facilitating drug access, whilst systematically analyzing treatment outcomes, are urgently needed. Methods: The Drug Rediscovery Protocol (DRUP) is an ongoing, prospective, non-randomized, multi-drug, and pan-cancer trial, in which patients with advanced cancer, who have exhausted all standard of care treatment options, are treated with either targeted or immunotherapy matched to their genetic tumor profile. All submitted patients are reviewed and enrolled in multiple parallel cohorts, preceded by a baseline tumor biopsy for whole genome sequencing to confirm previously identified variants and for exploratory biomarker analyses. Each cohort is defined by a study drug, histologic tumor type, and molecular tumor profile. Efficacy is analyzed per cohort: 8 patients in stage I and 16 more in stage II if ≥ 1 response is observed in the first stage. Primary endpoints include objective response rate, stable disease at 16 weeks, and grade ≥3 adverse events. Since the start of recruitment in September 2016, 870 patients have been submitted for review and 365 patients (42%) have started treatment in one of 101 opened cohorts. Eight cohorts have graduated to the second stage, two cohorts completed accrual in either their first or second stage, and one cohort was closed due to a registered indication. Twenty-two different study treatments (i.e. immunotherapy, monoclonal antibodies, and PARP/small molecule inhibitors), provided by 11 different pharmaceutical companies, are currently available in DRUP. Data sharing with similar trials such as TAPUR and CAPTUR enables to achieve completion of slow accruing cohorts and affirm conclusions. Clinical trial information: NCT02925234.
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Affiliation(s)
| | - Louisa Rose Hoes
- Netherlands Cancer Institute, Division of Molecular Oncology, Amsterdam, Netherlands
| | - Hanneke van der Wijngaart
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | | | - Alwin Huitema
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | | | - Elly J. Lugtenburg
- Erasmus MC Cancer Institute, Department of Hematology, Rotterdam, Netherlands
| | | | - Haiko Bloemendal
- Meander Medical Center, Division of Medical Oncology, Amersfoort, Netherlands
| | - Katrien Grunberg
- Radboud University Medical Center, Division of Pathology, Nijmegen, Netherlands
| | - Henk M.W. Verheul
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Hans Gelderblom
- Leiden University Medical Center, Department of Medical Oncology, Leiden, Netherlands
| | - Emile E. Voest
- Department of Medical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam and Center for Personalized Cancer Treatment, Rotterdam, Netherlands
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Lolkema MP, Plummer ER, De Vos FYFL, Forster MD, Angevin E, Libouban M, Jansen E, Tjwa M, Ciamporcero E, Meulemans A, Van der Aa A, Perera TPS, Clack G, Krebs M, Blagden SP. Modular phase I/II clinical trial evaluating the selective MET-kinase inhibitor OMO-1 in patients with advanced malignancies: Safety and proof of mechanism. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3062] [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
3062 Background: MET kinase is a therapeutic target in a range of cancer indications; it is a primary oncogenic driver and a mechanism of therapy resistance. OMO-1 is a highly potent, selective oral inhibitor of MET kinase and Organic Cation Transporter 2 (OCT2). Methods: This study assesses the safety, tolerability, pharmacokinetics (PK) and preliminary activity of OMO-1 in patients (pts) with advanced malignancies (NCT03138083). Module 1 data, evaluating ascending doses of OMO-1 monotherapy, are reported here. Results: As of January 16, 2019, 34 pts were enrolled at 5 twice-daily (BD) dose levels of OMO-1: 100, 200, 250, 350, and 400 mg, including 10 with MET gene amplified or mutated tumours. OMO-1 was generally well tolerated between 100 - 250 mg BD; pts were in the study for an average of 94 days (range: 15-291 days) and 20/34 pts discontinued due to disease progression. Most frequently-reported AEs were nausea (17/34), vomiting (14/34) and fatigue (14/34), mainly G1-2. Notably, no peripheral oedema, cardiovascular events or non-malignancy related LFT abnormalities were observed. A total of 36 SAEs were reported: 17 in 11 subjects were considered related to OMO-1, and included nausea (3/17), vomiting (4/17), chills, diarrhoea, influenza-like illness (2/17), increased blood bilirubin, blood creatinine (3/17) and neutrophil count, and sepsis. A dose of 250 mg BD was determined as the recommended Phase 2 dose (RP2D); doses ≥350mg BD were not in keeping with optimum long-term dosing: at 400 mg BD, 2/3 subjects experienced influenza-like illness (G2 and G3) and at 350 mg BD 2/5 subjects had G2 fatigue and nausea/vomiting. OMO-1 has a half-life of 2.5-3 hrs and plasma exposure is dose-proportional without accumulation. Elevated creatinine was observed across all dose levels, consistent with OCT2 inhibition. IHC analysis on paired tumour biopsies from a MET-mutated NSCLC pt dosed at 200 mg BD showed near-complete inhibition of phosphorylated MET, without affecting total MET. Conclusions: OMO-1 has a favourable safety profile at a RP2D of 250mg BD. Expansion cohorts for MET mutated/amplified tumour types are enrolling. Clinical trial information: NCT03138083.
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Affiliation(s)
| | | | | | | | - Eric Angevin
- Drug Development Department (DITEP), Institut Gustave Roussy, Villejuif, France
| | | | | | - Marc Tjwa
- OCTIMET Oncology NV, Beerse, Belgium
| | | | | | | | | | | | - Matthew Krebs
- The Christie NHS Foundation Trust and The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
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Roth P, Reijneveld JC, Gorlia T, Dhermain F, De Vos FYFL, Vanlancker M, O'Callaghan CJ, Le Rhun E, Van Den Bent MJ, Mason WP, Weller M. EORTC 1709/CCTG CE.8: A phase III trial of marizomib in combination with standard temozolomide-based radiochemotherapy versus standard temozolomide-based radiochemotherapy alone in patients with newly diagnosed glioblastoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.tps2072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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
TPS2072 Background: The standard treatment for patients with newly diagnosed glioblastoma comprises maximum safe surgery, radiotherapy (RT), and concomitant and up to six cycles of maintenance temozolomide (TMZ) chemotherapy (TMZ/RT→TMZ). Despite this intense therapy, the prognosis remains poor and there is an urgent need to develop new therapeutic options. Marizomib is a novel, irreversible and brain-penetrant pan-proteasome inhibitor. Following its successful assessment in phase I trials in patients with newly diagnosed as well as recurrent glioblastoma, marizomib is now being investigated in a phase III trial. Methods: EORTC 1709/CCTG CE.8 is a multicenter, randomized, controlled, open label phase III superiority trial. Eligibility criteria include histologically confirmed newly diagnosed glioblastoma and a performance status ≥70. Approximately a total of 750 patients will be enrolled and randomized 1:1. Stratification factors include institution, age, Karnofsky performance status and extent of surgery. The primary objective of this study is to compare overall survival in patients receiving marizomib in addition to standard of care (TMZ/RT→TMZ) with patients receiving standard treatment only. The testing strategy specifies the determination of this objective in both the intent-to-treat population and the subgroup of patients with tumors harboring an unmethylated MGMT promoter. Secondary endpoints include progression-free survival, safety, neurocognitive function and quality of life. The study is accompanied by a translational research program. The study will be opened at 50 EORTC sites in Europe and done as an intergroup collaboration with the Canadian Cancer Trials Group (CCTG) with 25 sites in Canada and additional sites in the US. Patient enrolment started in June 2018 and as of January 29, 2019, a total of 85 patients have been randomized. An update on the enrolment status will be provided at the ASCO conference. Clinical trial information: NCT03345095.
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Affiliation(s)
| | - Jaap C. Reijneveld
- Department of Neurology, VU University Medical Center, Amsterdam, Netherlands
| | | | | | | | | | | | | | | | - Warren P. Mason
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Michael Weller
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, and Neuroscience Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland
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6
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Plummer ER, Lolkema MP, Aerts JG, De Vos FYFL, Forster M, ANGEVIN ERIC, Kristeleit RS, Perera T, Clack G, Meulemans A, Libouban M, Hari Dass P, Drew Y, Tinsley N, Balaratnam S, Blagden SP, Krebs M. A modular, multi-arm, multi-part, first time in patient study to evaluate the safety and tolerability of the dual MET kinase/OCT2 inhibitor, OMO-1, alone and in combination with anti-cancer treatments, in patients with locally advanced, unresectable or metastatic solid malignancies. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps2614] [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)
- Elizabeth Ruth Plummer
- Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | - Yvette Drew
- Newcastle University, Northern Institute for Cancer Research, Newcastle-upon-Tyne, United Kingdom
| | | | | | | | - Matthew Krebs
- The Christie NHS Foundation Trust and The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
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7
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Sharma P, Dirix L, De Vos FYFL, Allison JP, Decoster L, Zaucha R, Park JO, Vanderwalde AM, Kataria RS, Ferro S, Patel G, Ben Y(B, Oh DY. Efficacy and tolerability of tremelimumab in patients with metastatic pancreatic ductal adenocarcinoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.470] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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
470 Background: Clinical activity and tolerability of the anti-CTLA-4 antibody, tremelimumab, has yet to be established in metastatic pancreatic ductal adenocarcinoma (mPDAC). In a Phase 2, multicenter, open label study (NCT02527434), tremelimumab was evaluated in pts with advanced solid tumors. We report a planned analysis of the safety and efficacy of tremelimumab monotherapy in a cohort of pts with mPDAC. Methods: Eligible pts were adults with histologically or cytologically confirmed mPDAC with tumor progression following prior standard first-line 5-FU- or gemcitabine-containing chemotherapy. Pts received tremelimumab 750 mg IV Q4W for 7 doses, followed by 750 mg Q12W for 2 doses, for up to a total of 12 mo (total 9 doses in 12 mo) or until disease progression or unacceptable toxicity. Pts were radiographically assessed Q6 wks relative to first dose. The primary endpoints were safety (evaluated by CTCAE v4.0) and objective response rate (ORR) by investigator assessments (evaluated by RECIST v1.1). Results: As of April 5, 2017, 20 mPDAC pts had received treatment and were evaluable for efficacy analysis. Median treatment duration was 1.8 mo. There were no observed objective responses (ORR 0%; 95% CI, 0.0, 16.8%). Of 20 pts, 2 were not evaluable and 18 had progressive disease (PD). Based on the full analysis set (N = 20), progression occurred in target lesions in 14 (70%), non-target lesions in 7 (35%), and new lesions in 13 (65%) pts (not mutually exclusive categories). At the time of progression, 11 (61%) pts were on treatment and 7 (39%) had discontinued treatment. Median overall survival was 4 mo (95% CI 2.83 - 5.42). Two (10%) pts were still in follow up at 12 mo after treatment initiation. Treatment-related AEs (trAEs) occurred in 14 pts (70%); grade ≥3 trAEs occurred in 6 pts (30%). Three pts (15%) discontinued therapy due to trAEs. There were no treatment-related deaths. Conclusions: Tremelimumab monotherapy did not appear to be active in mPDAC pts who had tumor progression following prior standard first-line 5-FU- or gemcitabine-containing chemotherapy. Clinical trial information: NCT02527434.
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Affiliation(s)
| | | | | | | | | | - Renata Zaucha
- Uniwersyteckie Centrum Kliniczne w Gdańsku, Gdańsk, Poland
| | - Joon Oh Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of (South)
| | | | | | | | | | | | - Do-Youn Oh
- Seoul National University Hospital, Seoul, Korea, Republic of (South)
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8
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Van Der Velden DL, Hamming LC, Verheul HM, Bloemendal H, Grunberg K, Huitema A, Lugtenburg PJ, De Vos FYFL, Gelderblom H, Voest EE. The Drug Rediscovery Protocol (DRUP). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.2547] [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
2547 Background: Bringing precision medicine to cancer patients remains a challenge. For many cancers, the relative contribution of tumor type, mutations or CNV to drug sensitivity remains unknown. In addition, drug access is generally limited to the labeled indication, bypassing rarer disease subgroups for which large trials are not feasible. An innovative trial that facilitates drug access, whilst systematically analyzing treatment outcomes and biomarkers, could help overcome these challenges. Methods: We designed a prospective, non randomized clinical trial in which patients with advanced cancer are treated with targeted or immunotherapy matched to their tumor profile, defined by genetic aberration, microsatellite instability (MSI) or high mutational load (HML). Upon a mandatory pre-treatment tumor biopsy for biomarker research, patients are enrolled in multiple parallel cohorts, each defined by study drug, histologic tumor type and molecular tumor profile. Efficacy is analyzed per cohort, enrolling 8 patients in stage I and 16 more in stage II if ≥1 response is observed in stage I. Study endpoints include objective tumor response (CR or PR), stable disease (SD) at 16 weeks and grade≥3 adverse events. The DRUP is registered at ClinicalTrials.gov (NCT02925234). Results: Since start of recruitment in Sep 2016, 76 patients have been submitted for review (mean per month 15, range 8-17) and 16 (21%) have started treatment in 10 different cohorts, directed at either ATM (n = 1; breast cancer), BRAF (n = 2; salivary duct carcinoma and ACUP), BRCA (n = 1; breast cancer), ERBB2 (n = 2; CRC), HML (n = 2; prostate and CRC), MSI (n = 5; CRC, GBM and urothelial carcinoma), RET (n = 1; NSCLC) or RAS-RAFwt (n = 2; SCC and sarcoma). Out of the 7 patients for whom response evaluation is available, PR (n = 2) or SD at 16 weeks (n = 1) was observed in 3 (43%). Thirteen study drugs (supplied by 6 pharmaceutical companies) are currently available, 6 more are expected soon. Conclusions: Execution of a nationwide multidrug precision oncology trial is feasible. It contributes to oncologists’ education on molecularly targeted therapies and to identification of early signs of activity in rare cancer subsets. Data sharing with similar studies such as TAPUR and CAPTUR will help to enlarge cohorts and affirm conclusions. Clinical trial information: NCT02925234.
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Affiliation(s)
| | | | - Henk M.W. Verheul
- Department of Medical Oncology, Cancer Center, Amsterdam, Netherlands
| | - Haiko Bloemendal
- Meander Medical Center, Division of Medical Oncology, Amersfoort, Netherlands
| | - Katrien Grunberg
- Radboud University Medical Center, Division of Pathology, Nijmegen, Netherlands
| | - Alwin Huitema
- Netherlands Cancer Institute, Division of Clinical Pharmacology, Amsterdam, Netherlands
| | | | | | | | - Emile E. Voest
- Netherlands Cancer Institute, Division of Molecular Oncology, Amsterdam, Netherlands
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9
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Van Den Bent MJ, Klein M, Smits M, Reijneveld JC, Idbaih A, Clement P, De Vos FYFL, Wick W, Mulholland PJ, Taphoorn MJ, Lewis J, de Heer I, Kros JM, Verschuere T, Golfinopoulos V, Gorlia T, French P. Final results of the EORTC Brain Tumor Group randomized phase II TAVAREC trial on temozolomide with or without bevacizumab in 1st recurrence grade II/III glioma without 1p/19q co-deletion. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.2009] [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
2009 Background: Although bevacizumab (BEV) is frequently used in recurrent grade II and III glioma without 1p/19q co-deletion, this use is without evidence from randomized trials. Methods: The TAVAREC trial (NCT01164189) is a randomized phase II study in locally diagnosed non-1p/19q co-deleted grade II or III glioma, with a first and contrast-enhancing recurrence after initial radiotherapy. Prior chemotherapy was allowed provided patients were at least 6 months off treatment. Patients were treated with either 200mg/m2 temozolomide (TMZ) day 1-5 every 4 weeks for a maximum of twelve cycles, or with the same TMZ regimen in combination with BEV 10 mg/kg every 2 weeks until progression. Response, Quality of Life (QOL, using the EORTC QOL C30/BCM20 questionnaire) and neurocognitive function (NCF) using a standardized test battery with Hopkins Verbal Learning, Trail Making test A/B and Controlled Oral Word Association were evaluated every 3 months. Primary endpoint is the Overall Survival (OS) rate at 12 months (OS12). Tumor samples were centrally analyzed for MGMT status (Illumina methylation arrays) and IDH1/2 mutations ( IDHmt). Results: Between 8/2/2011 and 31/7/2015, 155 patients were randomized; median age was 44 years, 88 (70%) of 125 tested tumors showed an IDHmt, 27% of patients had received prior chemotherapy. OS12 was 61% in the TMZ arm and 55% in the TMZ+BEV arm, with overlapping OS and progression free survival (PFS) Kaplan Meier curves and similar response rates (TMZ: 42%; TMZ + BEV: 49%). Post-progression, 33% of the TMZ and 17% of the TMZ + BEV patients received BEV. OS was longer in IDHmt tumors compared to IDH wild type tumors (15 mo vs 10.7 mo, p = 0.001) but PFS was clinically similar (6.7 mo vs 5.1 mo, p = 0.056). IDH mutational status was not predictive for benefit to BEV. Compliance to NCF testing and QOL was above 60% in the 1st year. At the group level, NCF was similar in the TMZ and in the TMZ+BEV patients. QOL and MGMTresults will be presented at the meeting. Conclusions: The addition of BEV to TMZ does not improve OS, PFS, or cognitive function in recurrent grade II and III 1p/19q intact gliomas; regardless of IDH mutational status. Clinical trial information: NCT01164189.
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Affiliation(s)
| | | | | | - Jaap C. Reijneveld
- Department of Neurology, VU University Medical Center, Amsterdam, Netherlands
| | | | | | | | | | | | | | | | | | - Johan M Kros
- Department of Neuropathology, Erasmus Medical Center – Cancer Institute, Rotterdam, Netherlands
| | | | | | - Thierry Gorlia
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
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10
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Schuler MH, Ascierto PA, De Vos FYFL, Postow MA, Van Herpen CM, Carlino MS, Sosman JA, Berking C, Long GV, Weise A, Gutzmer R, Kaatz M, McArthur GA, Schwartz G, Daud A, Maharry K, Yerramilli-Rao P, Zimmer L, Bozon V, Amaria RN. Phase 1b/2 trial of ribociclib+binimetinib in metastatic NRAS-mutant melanoma: Safety, efficacy, and recommended phase 2 dose (RP2D). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.9519] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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
9519 Background: Simultaneous inhibition of MEK and CDK4/6 may suppress MAPK pathway activation and cell-cycle checkpoint dysregulation in NRAS-mutant melanoma, resulting in enhanced antitumor activity. Phase 1b data are reported. Methods: The phase 1b primary objective was to determine maximum tolerated dose (MTD)/RP2D. A 28-d cycle of oral ribociclib (RIBO) once daily (QD) for 21 d + oral binimetinib (BINI) twice daily (BID) for 28 d, and a 21-d cycle of RIBO QD + BINI BID, both for 14 d per cycle, were evaluated. Secondary objectives were to evaluate efficacy, safety and pharmacodynamics. Results: Based on dose escalation (van Herpen, ESMO 2015), MTD was 600mg RIBO/45mg BINI for the 21-d and 200/45 for the 28-d regimens. Due to promising activity, the 28-d cycle was selected as RP2D(unconfirmed partial response [PR] with limited follow-up occurred in 35% of pts). This finding was supported by comparable and manageable safety and the Bayesian logistic regression model.As of Jan 2017, the RP2D was received by 16 pts in phase 1b (ECOG PS 0/1/2, 63%/31%/6%; elevated lactate dehydrogenase, 44%; stage IVM1c disease, 50%; prior ipilimumab [ipi], 44%; prior anti–programmed death [PD]-1/PD-L1, 31%). Median (range) exposure was 4 (0–13) mo. Common adverse events (AEs) were increased blood creatine phosphokinase, elevated AST, peripheral edema, acneiform dermatitis, diarrhea and fatigue. Common grade 3/4 AEs were elevated AST and ALT (19%/6%), nausea (19%/0%), rash (19%/0%), vomiting (6%/6%) and neutropenia (12%/0%). Confirmed PR (cPR) occurred in 4 pts (25%; time to response, 48–168 d), stable disease in 7 pts (44%), disease progression in 3 pts (19%); 2 pts (12%) were not evaluable. Among cPR pts, 3 had prior ipi and/or anti–PD-1/PD-L1. Median progression-free survival (mPFS) was 6.7 (95% CI, 3.5–9.2) mo. Sequence analysis of synchronous non- RAS genetic alterations will be presented. Conclusions: Combined RIBO/BINI at the selected RP2D had a manageable safety profile and favorable efficacy (based on mPFS) for NRAS-mutant melanoma in phase 1b. Based on these promising data, the phase 2 expansion is underway to assess antitumor activity at the RP2D. Clinical trial information: NCT01781572.
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Affiliation(s)
| | - Paolo A. Ascierto
- Istituto Nazionale Tumori “Fondazione G.Pascale”- IRCCS, Naples, Italy
| | | | - Michael Andrew Postow
- Weill Cornell Medical College and Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Matteo S. Carlino
- Westmead and Blacktown Hospitals and Melanoma Institute Australia, Sydney, Australia
| | - Jeffrey A. Sosman
- Robert H. Lurie Cancer Center of Northwestern University, Chicago, IL
| | - Carola Berking
- Department of Dermatology and Allergy, University Hospital of Munich (LMU), Munich, Germany
| | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Amy Weise
- Karmanos Cancer Institute, Detroit, MI
| | - Ralf Gutzmer
- Skin Cancer Center Hannover, Hannover Medical School, Hannover, Germany
| | | | | | - Gary Schwartz
- Columbia College of Physicians and Surgeons, New York, NY
| | - Adil Daud
- Melanoma Clinical Research, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | | | | | - Lisa Zimmer
- West German Cancer Center, University Hospital, Essen, Germany
| | | | - Rodabe Navroze Amaria
- The University of Texas MD Anderson Cancer Center, Melanoma Medical Oncology, Houston, TX
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Zer A, Verheijen R, De Vos FYFL, Hotte S, Eskens F, Pronk L, Siu LL, Schnell D, Steeghs N, Langenberg MHG, Hirte H, De Jonge MJ. A phase I study of BI 853520, an inhibitor of focal adhesion kinase (FAK), in patients with advanced or metastatic solid tumors. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.2541] [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)
- Alona Zer
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | | | | | - Sebastien Hotte
- Juravinski Cancer Centre, Escarpment Cancer Research Institute, Hamilton, ON, Canada
| | - Ferry Eskens
- Erasmus University Medical Center, Rotterdam, Netherlands
| | - Linda Pronk
- Boehringer Ingelheim Espana SA, Madrid, Spain
| | - Lillian L. Siu
- Division of Medical Oncology, Princess Margaret Cancer Center, Toronto, ON, Canada
| | | | | | | | - Hal Hirte
- Juravinski Cancer Centre, Escarpment Cancer Research Institute, Hamilton, ON, Canada
| | - Maja J. De Jonge
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
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Taal W, Oosterkamp HM, Walenkamp AM, Beerepoot LV, Hanse M, Buter J, Honkoop A, Boerman D, De Vos FYFL, Jansen RL, van den Berkmortel FW, Brandsma D, Kros JM, Bromberg JE, van Heuvel I, Smits M, van der Holt B, Vernhout R, Van Den Bent MJ. A randomized phase II study of bevacizumab versus bevacizumab plus lomustine versus lomustine single agent in recurrent glioblastoma: The Dutch BELOB study. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.2001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [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
2001 Background: Bevacizumab (BEV) is widely used in recurrent glioblastoma, alone or in combination with other agents. There is however no well-controlled trial to support the use for this indication. Methods: In a three-arm Dutch multicenter randomized phase II study (NTR 1929) patients were assigned to either BEV 10 mg/kg iv every 2 weeks, BEV 10 mg/kg iv every 2 weeks and 110 mg/m2 lomustine every 6 weeks, or lomustine 110 mg/m2every 6 weeks. Eligible were patients with histologically proven glioblastoma, with a first recurrence after chemo-irradiation with temozolomide, having concluded radiotherapy more than 3 months ago, with adequate bone marrow, renal and hepatic function, and WHO performance status (PS) 0-2. Primary endpoint was 9 months overall survival (OS); P0 was set at 35% and P1 at 55%. Progression was defined using RANO criteria. A safety review after the first 10 patients in the combination arm was preplanned. Results: Between December 2009 and November 2011, 153 patients were enrolled of whom 148 were considered eligible. Median age was 57 years (range, 24-77) and median WHO PS was 1. With respect to prognostic factors groups were well balanced. After review of the safety cohort the dosage lomustine in the combination arm was lowered to 90 mg/m2 because of hematological toxicity (predominantly thrombocytopenia without symptoms). At this lower lomustine dose level the combination treatment was in general well tolerated. Outcome: see Table. Conclusions: In this first well-controlled study on BEV in recurrent glioblastoma with a primary OS endpoint, combination treatment with bevacizumab and lomustine met the prespecified criterion for further investigation in clinical trials, whereas both drugs given as single agent failed to meet this criterion. Clinical trial information: NTR1929. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - J. Buter
- VU University Medical Center, Amsterdam, Netherlands
| | | | | | | | - Rob L. Jansen
- Department of Medical Oncology, Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Dieta Brandsma
- Department of Neurology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Johan M Kros
- Department of Neuropathology, Erasmus MC–Daniel den Hoed Cancer Center, Rotterdam, Netherlands
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