Combination of PDL-1 and PARP inhibition in an unselected population with metastatic castrate-resistant prostate cancer (mCRPC).

Authors

null

Fatima Karzai

National Cancer Institute at the National Institutes of Health, Bethesda, MD

Fatima Karzai , Ravi Amrit Madan , Helen Owens , Amy Hankin , Anna Couvillon , Lisa M Cordes , Farhad Fakhrejahani , Nicole D. Houston , Jane B. Trepel , Clara Chen , Daniel C. Edelman , Paul S. Meltzer , Seth M. Steinberg , James L. Gulley , William L. Dahut , Jung-min Lee

Organizations

National Cancer Institute at the National Institutes of Health, Bethesda, MD, National Cancer Institute, Bethesda, MD, Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, National Institutes of Health, Bethesda, MD, Women's Malignancies Branch, National Cancer Institute, Bethesda, MD, Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, Department of Nuclear Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, Center of Cancer Research, Bethesda, MD, Biostatistics and Data Management Section, CCR, National Cancer Institute, Bethesda, MD

Research Funding

NIH

Background: About 30% of sporadic mCRPC has defects in DNA repair pathways which may confer sensitivity to PARP inhibition. There is limited data about PDL1 inhibition in mCRPC. We hypothesize increased DNA damage by olaparib (O) will complement anti-tumor activity of immune checkpoint blocking antibody, durvalumab (D), in mCRPC:NCT02484404. Methods: Single arm pilot study with accrual of 25 patients (pts) with mCRPC and biopsiable disease. Prior treatment with enzalutamide and/or abiraterone is required. D is given at 1500 mg iv q28 days + O 300 mg po q12 h. Primary endpoint is PFS. Pretreatment and on-study core biopsies undergo mutational analysis. Results: 10 pts have enrolled (median age 65 yr [range 51-79], median baseline PSA: 85.78 [22.17-809.9 ng/mL]). 7 pts have GS ≥ 8. Grade 3/4 adverse events include anemia 2/7 (29%), thrombocytopenia, lymphopenia, neutropenia, nausea, fatigue, UTI, and lung infection [1/7 each, (14%)]. 5/7 pts (71%) on-study >2 months (mos) have PSA declines > 50%. Median PFS is 7.8 mos (95% CI: 1.8 mos-undefined). Conclusions: Preliminary data shows D+O is well tolerated with activity in an unselected population. Accrual is ongoing with biomarker analysis. Clinical trial information: NCT02484404

Time on-
study (mos)
Disease LocationPrior treatmentsMutationBest PSA response
7Bone and soft
tissue/viscera (A)
androgen deprivation therapy (ADT),
enzalutamide/PROSTVAC,
docetaxel, abiraterone
None identified in DNA damage
repair pathways (NI)
-79%
10AADT, abiraterone, docetaxel,
enzalutamide, sipuleucel-T
NI-94%*
*Partial Response,
RECISTv1.1
2AADT, casodex, docetaxel,
abiraterone+radium-223
NI15%
2Bone only (B)ADT, cetuximab, abiraterone,
enzalutamide, docetaxel,
sipuleucel-T
NI35%
7AADT, sipuleucel-T, enzalutamide/
PROSTVAC, doxetaxel+cabozantinib
NI-73%
6BADT, sipuleucel-T, enzalutamide,
docetaxel+dendritic cell vaccine
BRCA2(germline)-59%
4BADT, zometa vs. placebo, nonsteroidal
estrogen, abiraterone+radium 223,
enzalutamide
No tumor cells seen on
biopsy (NT)
-99%
2AADT, docetaxel x 6 cycles, sipuleucel-T,
abiraterone, enzalutamide/
bromodomain inhibitor
BRCA2 (germline)-26%
2BADT, enzalutamideNT-23%
<2AADT, enzalutamideBRCA2(somatic)pending

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Abstract Details

Meeting

2017 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Genitourinary (Prostate) Cancer

Track

Genitourinary Cancer—Prostate, Testicular, and Penile

Sub Track

Prostate Cancer - Advanced Disease

Clinical Trial Registration Number

NCT02484404

Citation

J Clin Oncol 35, 2017 (suppl; abstr 5026)

DOI

10.1200/JCO.2017.35.15_suppl.5026

Abstract #

5026

Poster Bd #

100

Abstract Disclosures

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