Phase II study of cabozantinib (cabo) in patients (pts) with recurrent/metastatic endometrial cancer (EC): A study of the Princess Margaret, Chicago, and California phase II consortia.

Authors

null

Neesha C. Dhani

Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

Neesha C. Dhani , Hal W. Hirte , Julia V. Burnier , Angela Jain , Marcus O. Butler , Stephanie Lheureux , Jean Hurteau , Stephen Welch , Koji Matsuo , Michael Method , Waldo Jimenez , Carolyn Johnston , Erica Stringer , Mihaela C. Cristea , Anjali Mehta , Judy Quintos , Susie Tan , Lisa Wang , John Joseph Wright , Amit M. Oza

Organizations

Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, Juravinski Cancer Centre, Hamilton, ON, Canada, University Health Network Princess Margaret Cancer Centre, Toronto, ON, Canada, Fox Chase Cancer Center, Havertown, PA, Northshore University Health Systems, University of Chicago, Evanston, IL, London Regional Cancer Program, London, ON, Canada, Los Angeles County Hospital/ University of Southern California, Los Angeles, CA, IU Simon Cancer Center, Indianapolis, IN, McMaster University, Hamilton, ON, Canada, University of Michigan, Ann Arbor, MI, University of Chicago Medical Center, Chicago, IL, Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, Princess Margaret Cancer Centre, Toronto, ON, Canada, University of Toronto, Toronto, ON, Canada, National Cancer Institute at the National Institutes of Health, Bethesda, MD

Research Funding

Other

Background: Recurrent/metastatic EC has a poor prognosis with no standard 2ndline therapy. Cabo is a multi-targeted kinase inhibitor of MET, VEGFR, TIE2, AXL & KIT, relevant in epithelial-stromal cross-talk. The role of MET/HGF in aggressive EC biology, where transient benefit of VEGF-targeting is due to MET/HGF, TIE2 & AXL, provides rationale for MET targeting in EC. Methods: PHL86 (NCI#9322/NCT01935934) is a multi-centre, phase II trial of cabo (60mg oral daily dose) in pts with EC recurring within a year of adjuvant chemotherapy (ctx), or with progression after 1 line of ctx for metastatic disease. Experimental (E) cohort was stratified by histology (serous (SER) vs endometroid (END)) in a Simon two-stage design for co-primary endpoints of response rate ( > 30%) & 12-week progression-free-survival (PFS) ( > 55%). Activity was defined as > 7 partial responses (PRs) or > 15 instances of 12 wk-PFS in 36 pts. Pts with rare histology EC were treated in a parallel exploratory (Ex) cohort. Results: From May 2013 to Nov 2016, 102 pts (E: 71; Ex: 31) have been treated with cabo after prior radiation (59) and/or ctx (no. lines: 1(77); 2(22)). Cabo was well tolerated with common toxicities of fatigue, nausea, diarrhea & hand-foot syndrome. Most frequent Grade 3/4 toxicity was hypertension (32/101 pts). Fistula/perforation occurred in 4 of 71 SER/END pts & 4 of 31 Ex pts; no risk factors were identified. In 33 END pts, 6 PRs & 24 instances of > 12-wk PFS were observed; median PFS is 4.8 mths (95% CI: 4.4 – 6.4) with estimated 6-mth PFS of 43% (95% CI: 27 to 59%). In 34 SER pts, 4 PRs & 20 instances of > 12-wk PFS were observed; median PFS is 4.0 mths (95% CI: 2.7 – 4.7) with estimated 6-mth PFS of 30% (95% CI: 15 to 46%). 4 pts have had PFS > 12 mths, 1 SER pt remains on study after 25mths. Mutational analysis demonstrated presence of KRAS with PTEN or PIK3CA mutations in 9 (SER/END) pts, of whom 8/9 pts met 12-wk PFS endpoint, with a median PFS 5.9 mth (4.1 to 15.4). Conclusions: Cabo has single agent activity in END and SER EC with durable disease control. Concurrent mutation in KRAS/PTEN/PIK3CA may enrich for response. The current data support further evaluation of cabo in EC. Clinical trial information: NCT01935934

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Abstract Details

Meeting

2017 ASCO Annual Meeting

Session Type

Poster Discussion Session

Session Title

Gynecologic Cancer

Track

Gynecologic Cancer

Sub Track

Uterine Cancer

Clinical Trial Registration Number

NCT01935934

Citation

J Clin Oncol 35, 2017 (suppl; abstr 5524)

DOI

10.1200/JCO.2017.35.15_suppl.5524

Abstract #

5524

Poster Bd #

346

Abstract Disclosures