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Janjigian YY, Shitara K, Moehler M, Garrido M, Salman P, Wyrwicz L, Yamaguchi K, Skoczylas T, Bragagnoli AC, Liu T, Schenker M, Yanez P, Tehfe M, Kowalyszyn R, Karamouzis MV, Bruges R, Zander T, Pazo-Cid R, Hitre E, Feeney K, Cleary JM, Poulart V, Cullen D, Lei M, Xiao H, Kondo K, Li M, Ajani JA. A plain language summary of the CheckMate 649 study: nivolumab in combination with chemotherapy compared to chemotherapy alone for untreated advanced or metastatic cancer of the stomach or esophagus. Future Oncol 2023. [PMID: 36919706 DOI: 10.2217/fon-2022-1149] [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] [Indexed: 03/16/2023] Open
Abstract
WHAT IS THIS SUMMARY ABOUT? This is a summary of the 1-year results of a clinical research study known as CheckMate 649 published in The Lancet in June 2021. The 2-year results on the participants' health and overall quality of life from the same study are in a second publication in Nature in March 2022. Until recently, chemotherapy was the only first treatment option for people with advanced or metastatic gastroesophageal adenocarcinoma who had not been treated before. Patients receiving chemotherapy lived on average for less than 1 year. Nivolumab is an immunotherapy that works by activating a person's immune system to fight back against cancer cells. The goal of CheckMate 649 was to find out if the combination of nivolumab and chemotherapy would help patients with advanced or metastatic gastroesophageal adenocarcinoma live longer and without their cancer getting worse. WHAT WERE THE RESULTS? Results from the final analysis are reported here. Of 1581 people who took part in the study, 789 received nivolumab and chemotherapy and 792 received chemotherapy. Researchers found that, on average, participants who received nivolumab and chemotherapy lived longer overall than those who received chemotherapy alone. The length of time participants lived without their cancer getting worse was also longer on average with nivolumab and chemotherapy than chemotherapy treatment alone. However, more participants in the nivolumab and chemotherapy group had side effects than those in the chemotherapy group. The three most common side effects in both types of treatment were nausea (urge to vomit), diarrhea and peripheral neuropathy. Participants who received nivolumab and chemotherapy had a lower risk of their cancer symptoms worsening and reported that they were 'less bothered' from side effects of treatment than those receiving chemotherapy alone. WHAT DO THE RESULTS MEAN? The nivolumab and chemotherapy combination is considered a new standard treatment option and is approved in several countries as a treatment for adults who have not been treated before for their advanced or metastatic gastroesophageal cancer based on results from CheckMate 649. Clinical Trial Registration: NCT02872116 (ClinicalTrials.gov).
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Affiliation(s)
- Yelena Y Janjigian
- Memorial Sloan Kettering Cancer Center & Weill Cornell Medical College, New York, NY, USA
| | - Kohei Shitara
- National Cancer Center Hospital East, Kashiwa, Japan
| | | | - Marcelo Garrido
- Clinica San Carlos de Apoquindo, Pontificia Universidad Católica, Santiago, Chile
| | | | - Lucjan Wyrwicz
- Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warszawa, Poland
| | | | - Tomasz Skoczylas
- II Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego, Medical University of Lublin, Lublin, Poland
| | | | - Tianshu Liu
- Zhongshan Hospital Fudan University, Shanghai, China
| | | | - Patricio Yanez
- Universidad de La Frontera, James Lind Cancer Research Center, Temuco, Chile
| | - Mustapha Tehfe
- Oncology Center - Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada
| | - Ruben Kowalyszyn
- Instituto Multidisciplinario de Oncologia, Clinica Viedma S.A., Viedma, Argentina
| | | | - Ricardo Bruges
- Instituto Nacional de Cancerologia E.S.E., Bogotá, Colombia
| | - Thomas Zander
- University of Cologne, Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düesseldorf; Gastrointestinal Cancer Group Cologne (GCGC), Cologne, Germany
| | | | - Erika Hitre
- National Institute of Oncology, Budapest, Hungary
| | - Kynan Feeney
- St John of God Murdoch Hospital, Murdoch, WA, Australia
| | | | | | | | - Ming Lei
- Bristol Myers Squibb, Princeton, NJ, USA
| | - Hong Xiao
- Bristol Myers Squibb, Princeton, NJ, USA
| | | | | | - Jaffer A Ajani
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Janjigian Y, Ajani J, Moehler M, Garrido M, Gallardo C, Shen L, Yamaguchi K, Wyrwicz L, Skoczylas T, Bragagnoli A, Liu T, Tehfe M, Elimova E, Li M, Poulart V, Lei M, Kondo K, Shitara K. LBA7 Nivolumab (NIVO) plus chemotherapy (Chemo) or ipilimumab (IPI) vs chemo as first-line (1L) treatment for advanced gastric cancer/gastroesophageal junction cancer/esophageal adenocarcinoma (GC/GEJC/EAC): CheckMate 649 study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Janjigian YY, Shitara K, Moehler M, Garrido M, Salman P, Shen L, Wyrwicz L, Yamaguchi K, Skoczylas T, Campos Bragagnoli A, Liu T, Schenker M, Yanez P, Tehfe M, Kowalyszyn R, Karamouzis MV, Bruges R, Zander T, Pazo-Cid R, Hitre E, Feeney K, Cleary JM, Poulart V, Cullen D, Lei M, Xiao H, Kondo K, Li M, Ajani JA. First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial. Lancet 2021; 398:27-40. [PMID: 34102137 PMCID: PMC8436782 DOI: 10.1016/s0140-6736(21)00797-2] [Citation(s) in RCA: 1235] [Impact Index Per Article: 411.7] [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: 12/21/2020] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND First-line chemotherapy for advanced or metastatic human epidermal growth factor receptor 2 (HER2)-negative gastric or gastro-oesophageal junction adenocarcinoma has a median overall survival (OS) of less than 1 year. We aimed to evaluate first-line programmed cell death (PD)-1 inhibitor-based therapies in gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma. We report the first results for nivolumab plus chemotherapy versus chemotherapy alone. METHODS In this multicentre, randomised, open-label, phase 3 trial (CheckMate 649), we enrolled adults (≥18 years) with previously untreated, unresectable, non-HER2-positive gastric, gastro-oesophageal junction, or oesophageal adenocarcinoma, regardless of PD-ligand 1 (PD-L1) expression from 175 hospitals and cancer centres in 29 countries. Patients were randomly assigned (1:1:1 while all three groups were open) via interactive web response technology (block sizes of six) to nivolumab (360 mg every 3 weeks or 240 mg every 2 weeks) plus chemotherapy (capecitabine and oxaliplatin every 3 weeks or leucovorin, fluorouracil, and oxaliplatin every 2 weeks), nivolumab plus ipilimumab, or chemotherapy alone. Primary endpoints for nivolumab plus chemotherapy versus chemotherapy alone were OS or progression-free survival (PFS) by blinded independent central review, in patients whose tumours had a PD-L1 combined positive score (CPS) of five or more. Safety was assessed in all patients who received at least one dose of the assigned treatment. This study is registered with ClinicalTrials.gov, NCT02872116. FINDINGS From March 27, 2017, to April 24, 2019, of 2687 patients assessed for eligibility, we concurrently randomly assigned 1581 patients to treatment (nivolumab plus chemotherapy [n=789, 50%] or chemotherapy alone [n=792, 50%]). The median follow-up for OS was 13·1 months (IQR 6·7-19·1) for nivolumab plus chemotherapy and 11·1 months (5·8-16·1) for chemotherapy alone. Nivolumab plus chemotherapy resulted in significant improvements in OS (hazard ratio [HR] 0·71 [98·4% CI 0·59-0·86]; p<0·0001) and PFS (HR 0·68 [98 % CI 0·56-0·81]; p<0·0001) versus chemotherapy alone in patients with a PD-L1 CPS of five or more (minimum follow-up 12·1 months). Additional results showed significant improvement in OS, along with PFS benefit, in patients with a PD-L1 CPS of one or more and all randomly assigned patients. Among all treated patients, 462 (59%) of 782 patients in the nivolumab plus chemotherapy group and 341 (44%) of 767 patients in the chemotherapy alone group had grade 3-4 treatment-related adverse events. The most common any-grade treatment-related adverse events (≥25%) were nausea, diarrhoea, and peripheral neuropathy across both groups. 16 (2%) deaths in the nivolumab plus chemotherapy group and four (1%) deaths in the chemotherapy alone group were considered to be treatment-related. No new safety signals were identified. INTERPRETATION Nivolumab is the first PD-1 inhibitor to show superior OS, along with PFS benefit and an acceptable safety profile, in combination with chemotherapy versus chemotherapy alone in previously untreated patients with advanced gastric, gastro-oesophageal junction, or oesophageal adenocarcinoma. Nivolumab plus chemotherapy represents a new standard first-line treatment for these patients. FUNDING Bristol Myers Squibb, in collaboration with Ono Pharmaceutical.
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Affiliation(s)
- Yelena Y Janjigian
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Kohei Shitara
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
| | - Markus Moehler
- Department of Medicine, Johannes-Gutenberg University Clinic, Mainz, Germany
| | - Marcelo Garrido
- Department of Hemato-Oncology, Clinica San Carlos de Apoquindo, Pontificia Universidad Católica, Santiago, Chile
| | - Pamela Salman
- Department of Medical Oncology, Oncovida Cancer Center, Fundación Arturo López Pérez, Providencia, Chile
| | - Lin Shen
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing, Peking University Cancer Hospital and Institute, Beijing, China
| | - Lucjan Wyrwicz
- Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland
| | - Kensei Yamaguchi
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomasz Skoczylas
- II Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego, Medical University of Lublin, Lublin, Poland
| | | | - Tianshu Liu
- Department of Medical Oncology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Michael Schenker
- Department of Medical Oncology, Sfantul Nectarie Oncology Center, Dolj, Romania
| | - Patricio Yanez
- Department of Internal Medicine, Oncology Unit, Universidad de La Frontera, Temuco, Chile
| | - Mustapha Tehfe
- Hematology-Oncology, Oncology Center-Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada
| | - Ruben Kowalyszyn
- Instituto Multidisciplinario de Oncologia, Clinica Viedma SA, Viedma, Argentina
| | - Michalis V Karamouzis
- Department of Biological Chemistry and Laiko General Hospital Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ricardo Bruges
- Internal Medicine, Clinical Oncology, Instituto Nacional de Cancerología Empresa Social del Estado, Bogotá, Colombia
| | - Thomas Zander
- Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Roberto Pazo-Cid
- Department of Medical Oncology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Erika Hitre
- Department of Chemotherapy, National Institute of Oncology, Budapest, Hungary
| | - Kynan Feeney
- Department of Oncology, Haematology and Palliative Care, St John of God Murdoch Hospital, Murdoch, WA, Australia
| | - James M Cleary
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Ming Lei
- Bristol Myers Squibb, Princeton, NJ, USA
| | - Hong Xiao
- Bristol Myers Squibb, Princeton, NJ, USA
| | | | | | - Jaffer A Ajani
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Moehler M, Shitara K, Garrido M, Salman P, Shen L, Wyrwicz L, Yamaguchi K, Skoczylas T, Campos Bragagnoli A, Liu T, Schenker M, Yanez P, Tehfe M, Poulart V, Cullen D, Lei M, Kondo K, Li M, Ajani J, Janjigian Y. LBA6_PR Nivolumab (nivo) plus chemotherapy (chemo) versus chemo as first-line (1L) treatment for advanced gastric cancer/gastroesophageal junction cancer (GC/GEJC)/esophageal adenocarcinoma (EAC): First results of the CheckMate 649 study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2296] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Exposito MJ, Akce M, Alvarez J, Assenat E, Balart L, Baron A, Decaens T, Heurgue-Berlot A, Martin A, Paik S, Poulart V, Sehbai A, Shimada M, Takemura N, Yoon J. Abstract No. 526 CheckMate-9DX: phase 3, randomized, double-blind study of adjuvant nivolumab vs placebo for patients with hepatocellular carcinoma (HCC) at high risk of recurrence after curative resection or ablation. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Jimenez Exposito M, Akce M, Alvarez J, Assenat E, Balart L, Baron A, Decaens T, Heurgue-Berlot A, Martin A, Paik S, Poulart V, Sehbai A, Shimada M, Takemura N, Yoon JH. CA209-9DX: Phase III, randomized, double-blind study of adjuvant nivolumab vs placebo for patients with hepatocellular carcinoma (HCC) at high risk of recurrence after curative resection or ablation. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy432.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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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Jimenez Exposito M, Akce M, Montero Alvarez J, Assenat E, Balart L, Baron A, Decaens T, Heurgue-Berlot A, Martin A, Paik S, Poulart V, Sehbai A, Takemura N, Yoon JH. CA209-9DX: phase III, randomized, double-blind study of adjuvant nivolumab vs placebo for patients with hepatocellular carcinoma (HCC) at high risk of recurrence after curative resection or ablation. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.166] [Citation(s) in RCA: 6] [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: 12/26/2022] Open
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Dimopoulos MA, Lonial S, White D, Moreau P, Palumbo A, San‐Miguel J, Shpilberg O, Anderson K, Grosicki S, Spicka I, Walter‐Croneck A, Magen H, Mateos M, Belch A, Reece D, Beksac M, Bleickardt E, Poulart V, Sheng J, Sy O, Katz J, Singhal A, Richardson P. Elotuzumab plus lenalidomide/dexamethasone for relapsed or refractory multiple myeloma: ELOQUENT-2 follow-up and post-hoc analyses on progression-free survival and tumour growth. Br J Haematol 2017; 178:896-905. [PMID: 28677826 PMCID: PMC6084289 DOI: 10.1111/bjh.14787] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/29/2017] [Indexed: 01/26/2023]
Abstract
The randomized phase III ELOQUENT-2 study (NCT01239797) evaluated the efficacy and safety of elotuzumab + lenalidomide/dexamethasone (ELd) versus lenalidomide/dexamethasone (Ld) in relapsed/refractory multiple myeloma. ELd reduced the risk of disease progression/death by 30% versus Ld (hazard ratio [HR] 0·70). Median time from diagnosis was 3·5 years. We present extended 3-year follow-up data. Endpoints included progression-free survival (PFS), overall response rate (ORR) and interim overall survival (OS). Exploratory post-hoc analyses included impact of time from diagnosis and prior lines of therapy on PFS, and serum M-protein dynamic modelling. ORR was 79% (ELd) and 66% (Ld) (P = 0·0002). ELd reduced the risk of disease progression/death by 27% versus Ld (HR 0·73; P = 0·0014). Interim OS demonstrated a trend in favour of ELd (P = 0·0257); 1-, 2- and 3-year rates with ELd versus Ld were: 91% versus 83%, 73% versus 69% and 60% versus 53%. In patients with ≥ median time from diagnosis and one prior therapy, ELd resulted in a 53% reduction in the risk of progression/death versus Ld (HR 0·47). Serum M-protein dynamic modelling showed slower tumour regrowth with ELd. Adverse events were comparable between arms. ELd provided a durable and clinically relevant improvement in efficacy, with minimal incremental toxicity.
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Affiliation(s)
- Meletios A. Dimopoulos
- Department of Clinical TherapeuticsNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Sagar Lonial
- Department of Hematology and Medical OncologyWinship Cancer InstituteEmory University School of MedicineAtlantaGAUSA
| | - Darrell White
- Division of HematologyQueen Elizabeth II Health Sciences Centre and Dalhousie UniversityHalifaxNSCanada
| | | | - Antonio Palumbo
- Myeloma UnitDivision of HaematologyUniversity of TorinoAzienda Ospedaliero‐Universitaria Città della Salute e della Scienza di TorinoTorinoItaly
| | - Jesus San‐Miguel
- Clinica Universidad de NavarraInvestigación Médica AplicadaIDISNACIBERONCPamplonaSpain
| | - Ofer Shpilberg
- Institute of HaematologyAssuta Medical CentersTel AvivIsrael
| | - Kenneth Anderson
- Division of Hematologic OncologyDana‐Farber Cancer InstituteBostonMAUSA
| | - Sebastian Grosicki
- Department of Cancer PreventionMedical University of SilesiaKatowicePoland
| | - Ivan Spicka
- 1st Department of Medicine – Department of HaematologyFirst Faculty of MedicineCharles University and General Teaching Hospital in PraguePragueCzech Republic
| | - Adam Walter‐Croneck
- Department of Haemato‐oncology and Bone Marrow TransplantationMedical University of LublinLublinPoland
| | - Hila Magen
- Davidoff Cancer CenterRabin Medical CenterPetah TikvaIsrael
| | - Maria‐Victoria Mateos
- Haematology DepartmentUniversity Hospital of Salamanca–Instituto de Investigación Biomédica de Salamanca (IBSAL)SalamancaSpain
| | - Andrew Belch
- Department of OncologyCross Cancer Institute and University of AlbertaEdmontonABCanada
| | - Donna Reece
- Department of Medical Oncology and HaematologyPrincess Margaret Cancer CentreTorontoONCanada
| | - Meral Beksac
- Department of HaematologyAnkara UniversityAnkaraTurkey
| | - Eric Bleickardt
- Oncology Clinical DevelopmentBristol‐Myers SquibbLawrencevilleNJUSA
| | | | - Jennifer Sheng
- Clinical Pharmacology & PharmacometricsBristol‐Myers SquibbLawrencevilleNJUSA
| | - Oumar Sy
- Global Biometric SciencesBristol‐Myers SquibbLawrencevilleNJUSA
| | - Jessica Katz
- Global Clinical Research (Research and Development Oncology)Bristol‐Myers SquibbLawrencevilleNJUSA
| | - Anil Singhal
- AbbVie Biotherapeutics Inc. (ABR)Redwood CityCAUSA
| | - Paul Richardson
- Department of Medical OncologyDana‐Farber Cancer InstituteBostonMAUSA
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Lonial S, Dimopoulos M, Palumbo A, White D, Grosicki S, Spicka I, Walter-Croneck A, Moreau P, Mateos MV, Magen H, Belch A, Reece D, Beksac M, Spencer A, Oakervee H, Orlowski RZ, Taniwaki M, Röllig C, Einsele H, Wu KL, Singhal A, San-Miguel J, Matsumoto M, Katz J, Bleickardt E, Poulart V, Anderson KC, Richardson P. Elotuzumab Therapy for Relapsed or Refractory Multiple Myeloma. N Engl J Med 2015; 373:621-31. [PMID: 26035255 DOI: 10.1056/nejmoa1505654] [Citation(s) in RCA: 992] [Impact Index Per Article: 110.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Elotuzumab, an immunostimulatory monoclonal antibody targeting signaling lymphocytic activation molecule F7 (SLAMF7), showed activity in combination with lenalidomide and dexamethasone in a phase 1b-2 study in patients with relapsed or refractory multiple myeloma. METHODS In this phase 3 study, we randomly assigned patients to receive either elotuzumab plus lenalidomide and dexamethasone (elotuzumab group) or lenalidomide and dexamethasone alone (control group). Coprimary end points were progression-free survival and the overall response rate. Final results for the coprimary end points are reported on the basis of a planned interim analysis of progression-free survival. RESULTS Overall, 321 patients were assigned to the elotuzumab group and 325 to the control group. After a median follow-up of 24.5 months, the rate of progression-free survival at 1 year in the elotuzumab group was 68%, as compared with 57% in the control group; at 2 years, the rates were 41% and 27%, respectively. Median progression-free survival in the elotuzumab group was 19.4 months, versus 14.9 months in the control group (hazard ratio for progression or death in the elotuzumab group, 0.70; 95% confidence interval, 0.57 to 0.85; P<0.001). The overall response rate in the elotuzumab group was 79%, versus 66% in the control group (P<0.001). Common grade 3 or 4 adverse events in the two groups were lymphocytopenia, neutropenia, fatigue, and pneumonia. Infusion reactions occurred in 33 patients (10%) in the elotuzumab group and were grade 1 or 2 in 29 patients. CONCLUSIONS Patients with relapsed or refractory multiple myeloma who received a combination of elotuzumab, lenalidomide, and dexamethasone had a significant relative reduction of 30% in the risk of disease progression or death. (Funded by Bristol-Myers Squibb and AbbVie Biotherapeutics; ELOQUENT-2 ClinicalTrials.gov number, NCT01239797.).
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Affiliation(s)
- Sagar Lonial
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.L.); National and Kapodistrian University of Athens, Athens (M.D.); A.O.U. San Giovanni Battista di Torino-Ospedale Molinette, Turin, Italy (A.P.); QEII Health Science Center and Dalhousie University, Halifax, NS (D.W.), Cross Cancer Institute and University of Alberta, Edmonton (A.B.), and Princess Margaret Cancer Centre, Toronto (D.R.) - all in Canada; Silesian Medical University, Katowice (S.G.), and Medical University of Lublin, Lublin (A.W.-C.) - both in Poland; Charles University Hospital, Prague, Czech Republic (I.S.); University Hospital, Nantes, France (P.M.); Complejo Asistencial Universitario de Salamanca-Instituto de Investigación Biomédica de Salamanca, Salamanca (M.-V.M.), and Clinica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, and Tel Aviv University, Ramat Aviv - both in Israel (H.M.); Ankara University, Ankara, Turkey (M.B.); Alfred Health-Monash University, Melbourne, VIC, Australia (A. Spencer); Barts and the London NHS Trust, London (H.O.); University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); Kyoto Prefectural University of Medicine, Kyoto (M.T.), and Nishigunma National Hospital, Shibukawa (M.M.) - both in Japan; Universitätsklinikum der Technische Universität, Dresden (C.R.), and Universitätsklinikum Würzburg, Würzburg (H.E.) - both in Germany; Zeikenhuis Netwerk Antwerpen (ZNA) Stuivenberg, Antwerp, Belgium (K.L.W.); AbbVie Biotherapeutics, Redwood City, CA (A. Singhal); Bristol-Myers Squibb, Princeton, NJ (J.K.), Wallingford, CT (E.B.), and Braine-l'Alleud, Belgium (V.P.); and Dana-Farber Cancer Institute, Boston (K.C.A., P.R.)
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Lonial S, Dimopoulos MA, Palumbo A, White D, Grosicki S, Spicka I, Walter-Croneck A, Moreau P, Mateos MV, Magen-Nativ H, Belch A, Reece DE, Beksac M, Taniwaki M, Röllig C, Singhal AK, Katz J, Bleickardt EW, Poulart V, Richardson PG. ELOQUENT-2: A phase III, randomized, open-label study of lenalidomide (Len)/dexamethasone (dex) with/without elotuzumab (Elo) in patients (pts) with relapsed/refractory multiple myeloma (RRMM). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8508] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sagar Lonial
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | | | - Antonio Palumbo
- A. O. U. San Giovanni Battista di Torino - Ospedale Molinette, Torino, Italy
| | - Darrell White
- QEII Health Sciences Center, Dalhousie University, Halifax, NS, Canada
| | - Sebastian Grosicki
- Department of Cancer Prevention, Faculty of Public Health, Silesian Medical University, Katowice, Poland
| | - Ivan Spicka
- Prague General Hospital, Prague, Czech Republic
| | | | | | | | | | - Andrew Belch
- Cross Cancer Institute and University of Alberta, Edmonton, AB, Canada
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Kudo M, Han G, Finn RS, Poon RTP, Blanc JF, Yan L, Yang J, Lu L, Tak WY, Yu X, Lee JH, Lin SM, Wu C, Tanwandee T, Shao G, Walters IB, Dela Cruz C, Poulart V, Wang JH. Brivanib as adjuvant therapy to transarterial chemoembolization in patients with hepatocellular carcinoma: A randomized phase III trial. Hepatology 2014; 60:1697-707. [PMID: 24996197 DOI: 10.1002/hep.27290] [Citation(s) in RCA: 243] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 06/27/2014] [Indexed: 02/05/2023]
Abstract
UNLABELLED Transarterial chemoembolization (TACE) is the current standard of treatment for unresectable intermediate-stage hepatocellular carcinoma (HCC). Brivanib, a selective dual inhibitor of vascular endothelial growth factor and fibroblast growth factor signaling, may improve the effectiveness of TACE when given as an adjuvant to TACE. In this multinational, randomized, double-blind, placebo-controlled, phase III study, 870 patients with TACE-eligible HCC were planned to be randomly assigned (1:1) after the first TACE to receive either brivanib 800 mg or placebo orally once-daily. The primary endpoint was overall survival (OS). Secondary endpoints included time to disease progression (TTDP; a composite endpoint based on development of extrahepatic spread or vascular invasion, deterioration of liver function or performance status, or death), time to extrahepatic spread or vascular invasion (TTES/VI), rate of TACE, and safety. Time to radiographic progression (TTP) and objective response rate were exploratory endpoints. The trial was terminated after randomization of 502 patients (brivanib, 249; placebo, 253) when two other phase III studies of brivanib in advanced HCC patients failed to meet OS objectives. At termination, median follow-up was approximately 16 months. Intention-to-treat analysis showed no improvement in OS with brivanib versus placebo (median, 26.4 [95% confidence interval {CI}: 19.1 to not reached] vs. 26.1 months [19.0-30.9]; hazard ratio [HR]: 0.90 [95% CI: 0.66-1.23]; log-rank P=0.5280). Brivanib improved TTES/VI (HR, 0.64 [95% CI: 0.45-0.90]), TTP (0.61 [0.48-0.77]), and rate of TACE (0.72 [0.61-0.86]), but not TTDP (0.94 [0.72-1.22]) versus placebo. Most frequent grade 3-4 adverse events included hyponatremia (brivanib, 18% vs. placebo, 5%) and hypertension (13% vs. 3%). CONCLUSIONS In this study, brivanib as adjuvant therapy to TACE did not improve OS.
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Affiliation(s)
- Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan
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Jassem J, Fein L, Karwal M, Campone M, Peck R, Poulart V, Vahdat L. Ixabepilone plus capecitabine in advanced breast cancer patients with early relapse after adjuvant anthracyclines and taxanes: A pooled subset analysis of two phase III studies. Breast 2012; 21:89-94. [DOI: 10.1016/j.breast.2011.09.003] [Citation(s) in RCA: 9] [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] [Received: 02/24/2011] [Revised: 08/31/2011] [Accepted: 09/01/2011] [Indexed: 11/28/2022] Open
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Ratain MJ, Schwartz GK, Oza AM, Rudin CM, Kaye SB, De Jonge MJ, Khayat D, Awada A, Sawyer MB, Obel JC, Medioni J, Evans TRJ, De Greve J, Soetekouw PM, Baurain J, O'Dwyer PJ, Hartman C, Poulart V, Walters IB. Brivanib (BMS-582664) in advanced solid tumors (AST): Results of a phase II randomized discontinuation trial (RDT). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3079] [Citation(s) in RCA: 18] [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: 11/20/2022] Open
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Schwartz GK, Maki RG, Ratain MJ, Undevia SD, Jones RL, Rudin CM, Siu LL, Brockstein B, Khayat D, Gil T, De Jonge MJ, Sawyer MB, Evans TRJ, Medioni J, O'Dwyer PJ, Hartman C, Poulart V, Walters IB. Brivanib (BMS-582664) in advanced soft-tissue sarcoma (STS): Biomarker and subset results of a phase II randomized discontinuation trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.10000] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sparano JA, Vrdoljak E, Rixe O, Xu B, Manikhas A, Medina C, Da Costa SCV, Ro J, Rubio G, Rondinon M, Perez Manga G, Peck R, Poulart V, Conte P. Randomized phase III trial of ixabepilone plus capecitabine versus capecitabine in patients with metastatic breast cancer previously treated with an anthracycline and a taxane. J Clin Oncol 2010; 28:3256-63. [PMID: 20530276 DOI: 10.1200/jco.2009.24.4244] [Citation(s) in RCA: 164] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We sought to determine whether the combination of ixabepilone plus capecitabine improved overall survival (OS) compared with capecitabine alone in patients with metastatic breast cancer (MBC) previously treated with anthracyclines and taxanes. PATIENTS AND METHODS A total of 1,221 patients with MBC previously treated with anthracycline and taxanes were randomly assigned to ixabepilone (40 mg/m(2) intravenously on day 1) plus capecitabine (2,000 mg/m(2) orally on days 1 through 14) or capecitabine alone (2,500 mg/m(2) on the same schedule) given every 21 days. The trial was powered to detect a 20% reduction in the hazard ratio (HR) for death. RESULTS There was no significant difference in OS between the combination and capecitabine monotherapy arm, the primary end point (median, 16.4 v 15.6 months; HR = 0.9; 95% CI, 078 to 1.03; P = .1162). The arms were well balanced with the exception of a higher prevalence of impaired performance status (Karnofsky performance status 70% to 80%) in the combination arm (32% v 25%). In a secondary Cox regression analysis adjusted for performance status and other prognostic factors, OS was improved for the combination (HR = 0.85; 95% CI, 0.75 to 0.98; P = .0231). In 79% of patients with measurable disease, the combination significantly improved progression-free survival (PFS; median, 6.2 v 4.2 months; HR = 0.79; P = .0005) and response rate (43% v 29%; P < .0001). Grade 3 to 4 neuropathy occurred in 24% treated with the combination, but was reversible. CONCLUSION This study confirmed a previous trial demonstrating improved PFS and response for the ixabepilone-capecitabine combination compared with capecitabine alone, although this did not result in improved survival.
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Affiliation(s)
- Joseph A Sparano
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
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Bunnell C, Vahdat L, Schwartzberg L, Gralow J, Klimovsky J, Poulart V, Peck R, Thomas E. Phase I/II Study of Ixabepilone plus Capecitabine in Anthracycline–Pretreated/Resistant and Taxane-Resistant Metastatic Breast Cancer. Clin Breast Cancer 2008; 8:234-41. [DOI: 10.3816/cbc.2008.n.026] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Thomas E, Tabernero J, Fornier M, Conté P, Fumoleau P, Lluch A, Vahdat LT, Bunnell CA, Burris HA, Viens P, Baselga J, Rivera E, Guarneri V, Poulart V, Klimovsky J, Lebwohl D, Martin M. Phase II Clinical Trial of Ixabepilone (BMS-247550), an Epothilone B Analog, in Patients With Taxane-Resistant Metastatic Breast Cancer. J Clin Oncol 2007; 25:3399-406. [PMID: 17606975 DOI: 10.1200/jco.2006.08.9102] [Citation(s) in RCA: 235] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Ixabepilone (BMS-247550) is an epothilone analog that optimizes the properties of naturally occurring epothilone B. Natural epothilones and their analogs promote tumor cell death by binding to tubulin and stabilizing microtubules, causing apoptosis. This international phase II trial assessed the activity of ixabepilone in patients with metastatic breast cancer (MBC) that was resistant to taxane therapy. Patients and Methods MBC patients, who had experienced disease progression while receiving or within 4 months of taxane therapy (6 months if adjuvant taxane only), and who had a taxane as their last regimen, received ixabepilone (1- or 3-hour infusion of 50 mg/m2 or 3-hour infusion of 40 mg/m2 every 3 weeks). Results Of 49 patients treated with 40 mg/m2 ixabepilone during 3 hours, 35 (73%) had experienced disease progression within 1 month of their last taxane dose. The response rate was 12% (95% CI, 4.7% to 26.5%). All responses (n = 6) were partial; five of six patients had not responded to prior taxane therapy. In responders, the median response duration was 10.4 months. In 20 patients (41%), stable disease was the best outcome. Median time to progression was 2.2 months (95% CI, 1.4 to 3.2 months); median survival was 7.9 months. For treated patients across all cohorts (intent-to-treat population), the response rate was also 12% (eight of 66). Treatment-related adverse events in the study were manageable and primarily grade 1/2. Treatment-related neuropathy was mostly sensory and mild to moderate. Conclusion Ixabepilone (40 mg/m2 as a 3-hour infusion every 3 weeks) demonstrates promising antitumor activity and an acceptable safety profile in patients with taxane-resistant MBC.
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Affiliation(s)
- Eva Thomas
- The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
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