Association of adverse events (AEs) with efficacy outcomes for cabozantinib (C) in patients (pts) with advanced hepatocellular carcinoma (aHCC) in the phase III CELESTIAL trial.

Authors

Ghassan Abou-Alfa

Ghassan K. Abou-Alfa

Memorial Sloan Kettering Cancer Center, New York, NY

Ghassan K. Abou-Alfa , Tim Meyer , Ann-Lii Cheng , Irfan Cicin , Luigi Bolondi , Heinz Josef Klümpen , Stephen Lam Chan , Vincenzo Dadduzio , Steven Milwee , Sarita Dubey , Robin Kate Kelley , Anthony B. El-Khoueiry

Organizations

Memorial Sloan Kettering Cancer Center, New York, NY, Royal Free Hospital, London, United Kingdom, National Taiwan University College of Medicine, Taipei, Taiwan, Trakya Üniversitesi, Edirne, Turkey, University of Bologna, Bologna, Italy, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands, State Key Laboratory in Oncology of South China, The Chinese University of Hong Kong, Shatin, Hong Kong, Istituto Oncologico Veneto-IRCCS, Padova, Italy, Exelixis, Inc., South San Francisco, CA, Amgen, South San Francisco, CA, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA

Research Funding

Pharmaceutical/Biotech Company

Background: Class-specific AEs occurring with tyrosine kinase inhibitors have been associated with improved efficacy outcomes in several tumor types including aHCC. In the phase 3 CELESTIAL trial (NCT01908426), C, an inhibitor of VEGFR, MET, and AXL, improved overall survival (OS) and progression-free survival (PFS) vs placebo (P) in pts with previously treated aHCC. Here, we retrospectively evaluate the association of palmar-plantar erythrodysaesthesia (PPE) and hypertension (HTN) with OS and PFS for C in the CELESTIAL trial. Methods: 707 pts with aHCC were randomized 2:1 to receive 60 mg C or P once daily. Eligible pts had Child-Pugh score A, ECOG PS ≤1, must have received prior sorafenib, and could have received up to two prior regimens of systemic therapy for HCC. OS and PFS with C were evaluated for pts with any grade PPE or grade ≥3 HTN within the first 8 weeks of study treatment. Results: Overall, 374 (80%) pts in the C arm and 179 (76%) pts in the P arm completed ≥8 weeks of treatment. In the first 8 weeks, 188 (40%) of C-treated pts developed any grade PPE vs 11 (5%) of P-treated pts, and 61 (13%) of C-treated pts developed grade ≥3 HTN vs 3 (1%) of P-treated pts. Median OS with C was 14.4 mo for pts with any grade PPE vs 8.4 mo for pts without PPE (HR 0.59, 95% CI 0.47-0.74), and median PFS with C was 6.5 mo vs 3.7 mo, respectively (HR 0.63, 95% CI 0.51-0.78). Median OS with C was 16.1 mo for pts with grade ≥3 HTN vs 9.5 mo for pts without grade ≥3 HTN (HR 0.56, 95% CI 0.39-0.80), and median PFS with C was 7.4 mo vs 4.4 mo, respectively (HR 0.59, 95% CI 0.43-0.82). Some imbalances in baseline characteristics were present. Pts with PPE had better ECOG PS (60% vs 47% ECOG 0), better liver function (48% vs 34% ALBI grade 1), and less macrovascular invasion (24% vs 30%) than those without. Likewise, pts with grade ≥3 HTN had better ECOG PS (61% vs 51% ECOG 0), better liver function (56% vs 37% ALBI grade 1), and less macrovascular invasion (20% vs 29%) than those without. Conclusions: The development of PPE or grade ≥3 HTN with C was associated with prolonged OS and PFS in pts with previously treated aHCC although some imbalances in baseline characteristics between comparator groups were present. Clinical trial information: NCT01908426

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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

NCT01908426

Citation

J Clin Oncol 37, 2019 (suppl; abstr 4088)

DOI

10.1200/JCO.2019.37.15_suppl.4088

Abstract #

4088

Poster Bd #

193

Abstract Disclosures