Ramucirumab (RAM) for sorafenib intolerant patients with hepatocellular carcinoma (HCC) and elevated baseline alpha fetoprotein (AFP): Outcomes from two randomized phase 3 studies (REACH, REACH2).

Authors

null

Josep M Llovet

Icahn School of Medicine at Mount Sinai, New York, NY

Josep M Llovet , Chia-Jui Yen , Richard S. Finn , Yoon-Koo Kang , Masatoshi Kudo , Peter R. Galle , Eric Assenat , Marc Pracht , Ho Yeong Lim , Kun-Ming Rau , Christophe Borg , Jean-Baptiste Hiriart , Bruno Daniele , Thomas Berg , Hyun Cheol Chung , Nathalie Godinot , Chunxiao Wang , Yanzhi Hsu , William R. Schelman , Andrew X. Zhu

Organizations

Icahn School of Medicine at Mount Sinai, New York, NY, National Cheng Kung University Hospital, Tainan, Taiwan, University of California, Los Angeles, Los Angeles, CA, Department of Oncology, Asan Medical Center, Seoul, South Korea, Kindai University, Faculty of Medicine, Osaka, Japan, University Medical Center, Mainz, Germany, CHU de Montpellier, Montpellier, France, Centre Eugène Marquis, Rennes, France, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea, E-Da Cancer Hospital and Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, University Hospital of Besançon, Besançon, France, CHU de Bordeaux, Pessac, France, Ospedale del Mare, Napoli, Italy, University of Leipzig, Section of Hepatology, Department of Gastroenterology and Rheumatology, Leipzig, Germany, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea, Eli Lilly and Company, Indianapolis, IN, Eli Lilly and Company, New York, NY, Massachusetts General Hospital Cancer Center, Harvard Medical Center, Boston, MA

Research Funding

Pharmaceutical/Biotech Company

Background: Oral multikinase inhibitors that have shown improvements in overall survival (OS) in HCC are associated with clinically important toxicities that commonly require dose adjustment or discontinuation (D/C) due to intolerance. REACH and REACH-2 studied RAM in patients (pts) with HCC who progressed on or were intolerant to sorafenib (SOR), and REACH-2 only enrolled pts with baseline AFP ≥400 ng/mL. In REACH-2 RAM treatment (trt) improved OS compared to placebo (P), supporting findings in REACH pts with baseline AFP ≥400 ng/mL. An exploratory analysis of outcomes by reason for D/C of SOR was performed. Methods: Pts had advanced HCC, Child-Pugh A, ECOG PS 0-1, and prior SOR. Pts were randomized to RAM 8 mg/kg or P Q2W. A pooled independent pt data analysis (stratified by study) of REACH-2 and REACH pts (AFP ≥400 mg/mL) was performed. Results are reported by reason for SOR D/C (intolerance or disease progression). OS and PFS were evaluated using Kaplan-Meier method and Cox proportional hazard model. Objective response rate (ORR), disease control rate (DCR) and safety are reported. Results: Baseline characteristics in the pooled population were generally balanced between trt arms in each subgroup. Median durations of prior SOR were 2.5 mo for SOR intolerant (n = 70) and 4.0 mo for SOR progressors (n = 472). Median OS (RAM v P) was 10.2 v 6.7 mo for SOR intolerant and 8.0 v 4.7 mo for SOR progressors (Table). Rates of D/C due to trt-related adverse events (AEs) (Table) (7% in each subgroup), and Grade ≥3 AEs (most frequently hypertension) were consistent with those observed in each study. Conclusions: Acknowledging limitations of sample size, the RAM trt benefit in SOR intolerant pts was consistent with that in the ITT population. RAM was well tolerated in SOR intolerant pts with low rates of D/C due to related-AEs. Clinical trial information: NCT01140347, NCT02435433

Analysis Population
(RAM v P)
SOR intolerantSOR progressors
N = 70
(RAM 42, P 28)
N = 472
(RAM 274, P 198)
OS median, mo10.2 v 6.78.0 v 4.7
    HR (95% CI)0.59 (0.34, 1.02)0.71 (0.58, 0.88)
PFS median, mo4.4 v 1.42.7 v 1.6
    HR (95% CI)0.32 (0.19, 0.55)0.64 (0.52, 0.79)
ORR, %12 v 04 v 1
DCR, %79 v 2153 v 39
D/C due to related AEs any grade, %12 v 09 v 4

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Abstract Details

Meeting

2019 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Gastrointestinal (Noncolorectal) Cancer

Track

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Sub Track

Hepatobiliary Cancer

Clinical Trial Registration Number

NCT01140347, NCT02435433

Citation

J Clin Oncol 37, 2019 (suppl; abstr 4073)

DOI

10.1200/JCO.2019.37.15_suppl.4073

Abstract #

4073

Poster Bd #

178

Abstract Disclosures