Identification of a high-response patient population to S-1 via predictive enrichment strategy analysis of the S-CUBE phase III trial.

Authors

null

Masatoshi Kudo

Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan

Masatoshi Kudo , Takuji Okusaka , Shuichi Kaneko , Junji Furuse , Madoka Takeuchi , Xuemin Fang , Yoshito Date , Masahiro Takeuchi

Organizations

Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan, Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan, Department of Gastroenterology, Kanazawa University Hospital, Ishikawa, Japan, Department of Medical Oncology, Kyorin University School of Medicine, Tokyo, Japan, Keio University, Tokyo, Japan, Department of Clinical Medicine, Kitasato University School of Pharmacy, Tokyo, Japan

Research Funding

Pharmaceutical/Biotech Company

Background: S-CUBE was a randomized, double-blind, phase III trial evaluating the efficacy and safety of S-1 in patients with sorafenib-refractory advanced hepatocellular carcinoma (HCC). The study’s primary outcome was presented at the 2015 ASCO Annual Meeting. Although S-1 did not significantly improve overall survival (OS) in all cohort (hazard ratio [HR] = 0.86; confidence interval [CI] = 0.67–1.10; P = 0.2201), we conducted predictive enrichment strategy analysis (PESA) to identify a patient population with a better response to S-1. Methods: Predictive enrichment strategy is a newly introduced concept proposed by the United States Food and Drug Administration, “to select a study population in which detection of a drug effect (if one is in fact present) is more likely than it would be in an unselected population. (Temple R. [2012] )” Therefore, in our study, PESA provides robust results and identifies advanced HCC patients who are more likely to respond to S-1. Clinically meaningful baseline characteristics were selected to create a scoring system; patients were ranked based on their scores, and the population with a better response was identified. Patient mapping was used to further characterize the population. Results: The full S-CUBE analysis set consisted of 333 patients, including 222 in the S-1 arm and 111 in the placebo. PESA and patient mapping identified 219 patients (65.8% of the total population) as the high-response patient population. High-response patients are classified as those with the following criteria; 1) TNM stage III, IVa, or IVb, 2) Child-Pugh class A, and 3) Levels of both the tumor markers are not high (AFP ≥ 400 ng/mL and PIVKA-II ≥ 10000 mAU/mL). In this population, the median OS of S-1 group was significantly longer than that of placebo group (426.0 days vs. 375.5 days; HR, 0.69; 95% CI, 0.51 to 0.93; P = 0.0156). Conclusions: PESA and patient mapping identified a high-response patient population to S-1. This statistically robust analysis demonstrated S-1 showed survival benefit for identified clinically-important population of sorafenib-refractory advanced HCC patients. Clinical trial information: JapicCTI-090920.

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Abstract Details

Meeting

2016 Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session B: Cancers of the Pancreas, Small Bowel, and Hepatobiliary Tract

Track

Cancers of the Pancreas, Small Bowel, and Hepatobiliary Tract

Sub Track

Translational Research

Clinical Trial Registration Number

JapicCTI-090920

Citation

J Clin Oncol 34, 2016 (suppl 4S; abstr 229)

DOI

10.1200/jco.2016.34.4_suppl.229

Abstract #

229

Poster Bd #

B17

Abstract Disclosures