Biomarker analyses from JAVELIN Renal 101: Avelumab + axitinib (A+Ax) versus sunitinib (S) in advanced renal cell carcinoma (aRCC).

Authors

Toni Choueiri

Toni K. Choueiri

The Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA

Toni K. Choueiri , Laurence Albiges , John B. A. G. Haanen , James M.G. Larkin , Motohide Uemura , Sumanta K. Pal , Gwenaelle Gravis , Matthew T Campbell , Konstantin Penkov , Jae-Lyun Lee , Keith A. Ching , Xinmeng Jasmine Mu , Xiao Wang , Weidong Zhang , Jing Wang , Aleksander Chudnovsky , Alessandra di Pietro , Paul B. Robbins , Robert J. Motzer

Organizations

The Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, Institut Gustave Roussy, Villejuif, France, The Netherlands Cancer Institute, Amsterdam, Netherlands, Royal Marsden NHS Foundation Trust, London, United Kingdom, Osaka University Hospital, Osaka, Japan, City of Hope Comprehensive Cancer Center, Duarte, CA, Institut Paoli Calmettes, Marseille, France, The University of Texas MD Anderson Cancer Center, Houston, TX, Private Medical Institution “Euromedservice”, St. Petersburg, Russian Federation, University of Ulsan College of Medicine, Seoul, South Korea, Pfizer Inc., San Diego, CA, Pfizer Inc., Cambridge, MA, Pfizer SRL, Milano, Italy, Memorial Sloan Kettering Cancer Center, New York, NY

Research Funding

Pharmaceutical/Biotech Company

Background: The phase 3 JAVELIN Renal 101 trial in previously untreated patients (pts) with aRCC demonstrated a progression-free survival (PFS) benefit and higher objective response rate with A+Ax vs S (Motzer, ESMO 2018; LBA6_PR). Here, we report outcomes from biomarker analyses of baseline tumor samples. Methods: We correlated efficacy with the results of molecular analyses of tissue samples from all 886 pts enrolled in JAVELIN Renal 101. Nephrectomy or tumor samples were characterized by immunohistochemistry (CD8 and PD-L1), whole-exome sequencing (WES), and RNAseq. WES and RNAseq were used to examine somatic mutations and analyze relevant gene expression signatures (GES) in relation to clinical outcomes. GES analyses included published and de novo signatures: effector T cell (Teff), angiogenesis (angio),T cell-inflamed (Tinf), and a novel immune-related signature incorporating pathway indicators for T- and NK-cell activation and IFNγ signaling, among others. Results: PD-L1 expression (≥1% immune cells) was associated with the longest PFS in the A+Ax arm and the shortest in the S arm (HR, 0.63; 95% CI, 0.49, 0.81). Significant treatment arm–specific differences in PFS were observed relative to wildtype when mutations in genes such as CD1631L, PTEN, or DNMT1 were present. Tumor mutational burden did not distinguish pts with respect to PFS. High-angio GES was associated with significantly improved PFS in the S arm but did not differentiate PFS in the A+Ax arm. In the low-angio subset, A+Ax improved PFS vs S. Pts with high Teff and Tinf in the A+Ax arm had longer PFS vs the S arm. In the A+Ax arm, PFS was enhanced in patients with immune GES–positive tumors vs those in the negative group (HR, 0.63; 95% CI, 0.46, 0.86; 2-sided p = 0.004), as well as in an independent dataset (JAVELIN Renal 100; Choueiri, Lancet Oncol, 2018) (HR, 0.46; 95% CI, 0.20, 1.05; 2-sided p = 0.064). Updated efficacy, including overall survival, will be presented. Conclusions: These findings define molecular features that differentiate therapy-specific outcomes in first-line aRCC and may inform personalized therapy strategies for pts with aRCC. Funding: Pfizer and Merck KGaA. Clinical trial information: NCT02684006

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Abstract Details

Meeting

2019 ASCO Annual Meeting

Session Type

Clinical Science Symposium

Session Title

Fine-Tuning Checkpoint Inhibition: Biomarkers of Response and Resistance

Track

Special Sessions

Sub Track

Immune Checkpoint Inhibitors

Clinical Trial Registration Number

NCT02684006

Citation

J Clin Oncol 37, 2019 (suppl; abstr 101)

DOI

10.1200/JCO.2019.37.15_suppl.101

Abstract #

101

Abstract Disclosures

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First Author: Toni K. Choueiri

First Author: Toni K. Choueiri