Biomarker analyses and association with clinical outcomes in patients with advanced hepatocellular carcinoma (HCC) treated with sorafenib with or without erlotinib in the phase III SEARCH trial.

Authors

null

Andrew X. Zhu

Massachusetts General Hospital Cancer Center, Boston, MA

Andrew X. Zhu , Yoon-Koo Kang , Olivier Rosmorduc , T.R. Jeffry Evans , Armando Santoro , Paul J. Ross , Edward Gane , Arndt Vogel , Michael Jeffers , Gerold Meinhardt , Carol Elaine Pena

Organizations

Massachusetts General Hospital Cancer Center, Boston, MA, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, Service d'Hépatologie, Hopital St Antoine, Paris, France, Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom, Humanitas Cancer Center, Milano, Italy, Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom, New Zealand Liver Transplant Unit, University of Auckland, Auckland, New Zealand, Hannover Medical School, Hannover, Germany, Bayer HealthCare Pharmaceuticals, Whippany, NJ

Research Funding

Pharmaceutical/Biotech Company

Background: Sorafenib (S) is the current standard therapy for advanced HCC but validated biomarkers predicting its clinical outcome are lacking. The present study aimed to identify biomarkers predicting prognosis and/or response to S ± erlotinib (E) in HCC patients from the randomized phase III SEARCH trial. Methods: A total of 720 patients were randomized to receive oral S 400 mg bid plus either E 150 mg qd or placebo (P). VEGF-A, VEGF-C, PDGF-BB, KIT (extracellular domain), HGF, bFGF, IGF-2, amphiregulin, betacellulin, EGF, epigen, epiregulin, heregulin, hbEGF, and TGF-a were measured in baseline plasma samples. Mutations in 19 oncogenes were analyzed in archival biopsies (Sequenom OncoCarta). Results: Baseline plasma biomarker data were available for 494 (69%) patients; n=243 S/E and 251 S/P. Treatment-independent analyses (combining both treatment arms) indicated that elevated HGF was associated with poor overall survival (OS; HR=0.598 [low vs high expression], multiplicity adjusted (adj) p=0.0007). Elevated plasma VEGF-A levels and low levels of KIT showed a similar trend towards poor survival (VEGF-A: HR=0.722 [low vs high expression], p=0.03, adj-p=0.39; KIT: HR=0.713 [high vs low expression], p=0.05, adj-p=0.60). High levels of plasma VEGF-C correlated with longer time to tumor progression (HR=0.626 [high vs low expression], adj-p=0.0042). Finally, in 67% of evaluable patients (339/494), a multi-marker composite signature consisting of HGF, VEGF-A, KIT, epigen, and VEGF-C correlated with improved OS: median OS 349 vs 184 days, HR=0.505, p=0.00002. None of the 15 baseline plasma biomarkers predicted efficacy from E in biomarker-treatment interaction analyses. Oncogenic mutations were detected in only 2 patient samples. Conclusions: HGF, VEGF-A, KIT, and VEGF-C baseline plasma levels were associated with clinical outcomes in HCC patients treated with S ± E, and these biomarkers plus epigen constituted a multi-marker composite signature for improved OS. Because S was used in both arms, whether these biomarkers are prognostic or also predictive of benefit from S alone in this population remains to be determined. Clinical trial information: NCT0901901.

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Abstract Details

Meeting

2014 ASCO Annual Meeting

Session Type

Poster Highlights Session

Session Title

Gastrointestinal (Noncolorectal) Cancer

Track

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Sub Track

Hepatobiliary Cancer

Clinical Trial Registration Number

NCT0901901

Citation

J Clin Oncol 32:5s, 2014 (suppl; abstr 4028^)

DOI

10.1200/jco.2014.32.15_suppl.4028

Abstract #

4028^

Poster Bd #

47

Abstract Disclosures