Ramucirumab for patients with intermediate-stage hepatocellular carcinoma (HCC) and elevated alpha fetoprotein (AFP): Pooled results from two phase III studies (REACH and REACH-2).

Authors

null

Masatoshi Kudo

Department of Gastroenterology and Hepatology, Kindai University School of Medicine, Osaka, Japan

Masatoshi Kudo , Richard S. Finn , Manabu Morimoto , Kun-Ming Rau , Masafumi Ikeda , Chia-Jui Yen , Peter R. Galle , Josep M. Llovet , Bruno Daniele , Ho Yeong Lim , Kun Liang , Kenta Shinozaki , Chunxiao Wang , Reigetsu Yoshikawa , Paolo Abada , Ryan C. Widau , Andrew X. Zhu

Organizations

Department of Gastroenterology and Hepatology, Kindai University School of Medicine, Osaka, Japan, University of California Los Angeles, Los Angeles, CA, Kanagawa Cancer Center, Yokohama, Japan, Division of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan, Division of Hematology and Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, Universitätsmedizin Mainz, Mainz, Germany, Icahn School of Medicine at Mount Sinai, New York, NY, Ospedale del Mare, Naples, Italy, Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Seoul, South Korea, Eli Lilly and Company, Indianapolis, IN, Massachusetts General Hospital, Boston, MA

Research Funding

Pharmaceutical/Biotech Company
None Eli Lilly and Company

Background: Intermediate-stage HCC, as defined as Barcelona Clinic Liver Cancer (BCLC) Stage B, is a heterogeneous disease in terms of liver function and tumor load. REACH (NCT01140347) and REACH-2 (NCT02435433) investigated ramucirumab (RAM) in patients (pts) with HCC after prior sorafenib (SOR), with REACH-2 enrolling only pts with baseline AFP ≥400 ng/mL. An exploratory analysis of outcomes by BCLC stage was performed. Methods: All pts had HCC (BCLC stage C or B disease refractory/not amenable to locoregional therapy), Child-Pugh A, ECOG PS 0-1, and prior SOR. Pts were randomized to RAM 8 mg/kg or Placebo (P) Q2W. A pooled meta-analysis of independent pt data (stratified by study) from REACH-2 and REACH (AFP ≥400 mg/mL) was performed. Prognosis of BCLC staging in overall survival (OS) was evaluated by multivariate Cox PH model (adjusted for baseline AFP and treatment (trt) arm); Trt effects in BCLC stage B and C by Cox PH model; median OS/PFS were estimated by Kaplan-Meier method. Objective response rate (ORR) per RECIST v1.1, disease control rate (DCR), and adverse events (AEs) were also reported by BCLC. Liver function was assessed at baseline and prior to each trt with the Albumin-Bilirubin (ALBI) linear predictor. Results: Baseline characteristics were generally balanced between trt arms in each BCLC stage. BCLC staging trended as an independent prognosis factor for OS [B v C; HR = 0.756 (0.546, 1.046)]. A consistent trt benefit for RAM v P was observed across staging (Table). Grade ≥3 AEs were consistent with observations from both individual studies; hypertension was the most frequent grade ≥3 AE. No difference in liver function, as measured by ALBI, was observed between trt arms in either BCLC stage. Conclusions: Acknowledging limitations of sample size, RAM provided a survival benefit irrespective of BCLC stage. RAM was well tolerated and did not alter liver function compared to P. Clinical trial information: NCT01140347, NCT02435433

BCLC B C
Pooled Population
(RAM v P)
N = 52
(RAM 30, P 22)
N = 490
(RAM 286, P 204)
OS median, mo 13.7 v 8.2 7.7 v 4.8
    HR (95% CI) 0.43 (0.23, 0.83) 0.72 (0.59, 0.89)
PFS median, mo 4.2 v 2.8 2.8 v 1.5
    HR (95% CI) 0.33 (0.17, 0.64) 0.60 (0.49, 074)
ORR, % 17 v 5 4 v 1
DCR, % 80 v 59 54 v 35

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Abstract Details

Meeting

2020 Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session B: Hepatobiliary Cancer, Neuroendocrine/Carcinoid, Pancreatic Cancer, and Small Bowel Cancer

Track

Hepatobiliary Cancer,Neuroendocrine/Carcinoid,Pancreatic Cancer,Small Bowel Cancer,Other GI Cancer

Sub Track

Therapeutics

Clinical Trial Registration Number

NCT01140347, NCT02435433

Citation

J Clin Oncol 38, 2020 (suppl 4; abstr 549)

Abstract #

549

Poster Bd #

D10

Abstract Disclosures