A pilot study of avelumab in Epstein-Barr virus-associated gastric cancer.

Authors

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Ronan Andrew Mc Laughlin

Dept. Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland

Ronan Andrew Mc Laughlin , John Aird , Orla McCormack , C. DeGascun , R. Hussein , B. Molloy , A. Malara , M. Galligan , Catherine Margaret Kelly , Peter Doran , Austin G. Duffy

Organizations

Dept. Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland, Virus Reference Laboratory, University College Dublin, Dublin, Ireland, Clinical Research Centre, UCD University College Dublin, Dublin, Ireland, Clinical Trials Research Unit, Institute for Cancer Research, Dublin, Ireland

Research Funding

Pharmaceutical/Biotech Company
MERCK

Background: Gastric Cancer (GC) is the third most common cause of cancer related deaths worldwide. The median overall survival of patients with stage 4 disease is approximately 1 year. Current accepted treatment approach with chemotherapy is applied with little consideration for known genetic or biologic heterogeneity. Whilst immune-based approaches in GC look promising it is clear that single-agent PD1/PDL1 inhibition benefit a minority. We must clarify a means of identifying prospectively those patients who may benefit from this treatment. A recent landmark paper by The Cancer Genome Atlas (TCGA) proposed a classification of GC into four subtypes: Epstein-Barr-virus (EBV)-positive, microsatellite instable (MSI), chromosomal instable (CI), and genomically stable (GS). Two of the four – EBV and MSI subtypes – are likely to be immunogenic and amenable to PD1/PDL1 inhibition. Recent advances have shown EBV-positive tumors to be infiltrated by lymphocytes and be enriched for PDL1. Methods: This single centre single-arm pilot study in gastric or junctional adenocarcinoma will explore the hypothesis that administering anti-PDL1 therapy (Avelumab) in a prospectively identified population enriched for potential responders will result in improved outcomes. The anticipated frequency of EBV associated-GC (c10%) means that approximately N = 100 patients will be screened to identify N = 10 participants. If a positive signal for efficacy is seen this will provide a basis for a larger, multicentre study. Previously treated Patients with confirmation of stage 4 EBV- positive gastric or oesophago-gastric adenocarcinoma meeting eligibility criteria will be enrolled. Avelumab will be administered at a dose of 10mg/kg IV every 14days. Primary endpoint is to determine the 6-month progression free survival (PFS) of Avelumab in EBV-associated GC. Secondary endpoints include overall response rate, overall survival, median PFS time and feasibility/accrual rate at 12 months. Exploratory endpoints will be to evaluate changes in immune parameters in the peripheral blood over time. Kaplan-Meier methods for primary efficacy endpoint with two-tailed one-sample proportion test will be used to evaluate the evidence to reject the null hypothesis. Clinical trial information: 2018-002085-39.

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Abstract Details

Meeting

2020 Gastrointestinal Cancers Symposium

Session Type

Trials in Progress Poster Session

Session Title

Trials in Progress Poster Session A: Esophageal and Gastric Cancer and Other GI Cancers

Track

Esophageal and Gastric Cancer,Other GI Cancer

Sub Track

Therapeutics

Clinical Trial Registration Number

2018-002085-39

Citation

J Clin Oncol 38, 2020 (suppl 4; abstr TPS473)

Abstract #

TPS473

Poster Bd #

L17

Abstract Disclosures