Randomized phase II study of second-line modified FOLFIRI with PARP inhibitor ABT-888 (Veliparib) (NSC-737664) versus FOLFIRI in metastatic pancreatic cancer (mPC): SWOG S1513.

Authors

E. Gabriela Chiorean

E. Gabriela Chiorean

University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA

E. Gabriela Chiorean , Katherine A Guthrie , Philip Agop Philip , Elizabeth M. Swisher , Florencia Jalikis , Michael J. Pishvaian , Jordan Berlin , Marcus Smith Noel , Jennifer Marie Suga , Ignacio Garrido-Laguna , Dana Backlund Cardin , Danika L. Lew , Andrew M. Lowy , Howard S. Hochster

Organizations

University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, SWOG Statistics and Data Management Center, and Fred Hutchinson Cancer Research Center, Seattle, WA, Karmanos Cancer Institute, Detroit, MI, University of Washington School of Medicine, Seattle, WA, University of Washington Medical Center, Seattle, WA, Georgetown University Medical Center, Washington, DC, Vanderbilt University, Nashville, TN, University of Rochester James P. Wilmot Cancer Institute, Strong Memorial Hospital, Rochester, NY, Kaiser Permanente, Vallejo, CA, University of Utah Huntsman Cancer Institute, Salt Lake City, UT, Vanderbilt-Ingram Cancer Center, Nashville, TN, SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA, UCSD Moores Cancer Center, La Jolla, CA, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ

Research Funding

U.S. National Institutes of Health

Background: PC is characterized by DNA Damage Repair (DDR) deficiencies, including in BRCA1/2, ATM, and FANC genes. Given preclinical synergism between veliparib with irinotecan, safety and preliminary efficacy, we designed a randomized phase II study of mFOLFIRI (no 5-FU bolus) + veliparib vs FOLFIRI alone for 2nd line mPC patients (pts). Methods: Eligible pts had mPC, adequate organ function, ECOG PS 0-1, and 1 prior non-irinotecan systemic therapy.143 pts were to be randomized (1:1) to veliparib vs control. Primary endpoint was overall survival (OS). All pts had blood and tumor biopsies at baseline to assess germline and somatic BRCA1/2 mutations (integrated), and homologous recombination (HR) or DDR biomarkers (exploratory). Results: 123 pts were accrued between 09/2016 to 12/2017, and 108 were included in this analysis. 117 pts were biomarker evaluable: 109 blood/106 tumors. 11 cancers (9%) had HR deficiency (HRD), including 4 germline (BRCA1, BRCA2, ATM) and 7 somatic mutations (BRCA2, PALB2, ATM, CDK12). Additional 24 cancers (20%) had germline (n = 11, e.g., FANC, BLM, SLX4, CHEK2) or somatic mutations (n = 13, e.g., FANC, BLM, POLD1, RIF1, MSH2, MSH6) in other DNA repair genes, not classified as HRD. A planned interim futility analysis at 35% of expected PFS events determined the veliparib arm was unlikely to be superior to control. Most common grade 3/4 treatment related toxicities were neutropenia (33% vs 20%), fatigue (19% vs 4%), and nausea (11% vs 4%), for veliparib vs control. Treatment exposure was similar for veliparib vs control: median 4 cycles (range 1-31 vs 1-32). Median OS was 5.1 vs 5.9 mos (HR 1.3, 95%CI 0.9-2.0, p = 0.21), and median PFS was 2.1 vs 2.9 mos (HR 1.5, 95%CI 1.0-2.2, p = 0.05) for veliparib vs control arms, respectively. Correlations of gene mutations and signatures with efficacy outcomes will be presented. Conclusions: Nearly 30% of mPC pts had DNA repair gene abnormalities, including 9% with HRD. Veliparib increased toxicity and did not improve OS when added to mFOLFIRI in biomarker unselected pts. BRCA1/2 and DDR biomarkers will be correlated with efficacy to inform patient selection for future PARP inhibitor clinical trials. Clinical trial information: NCT02890355

Disclaimer

This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org

Abstract Details

Meeting

2019 ASCO Annual Meeting

Session Type

Poster Discussion Session

Session Title

Gastrointestinal (Noncolorectal) Cancer

Track

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Sub Track

Pancreatic Cancer

Clinical Trial Registration Number

NCT02890355

Citation

J Clin Oncol 37, 2019 (suppl; abstr 4014)

DOI

10.1200/JCO.2019.37.15_suppl.4014

Abstract #

4014

Poster Bd #

119

Abstract Disclosures