Molecular characteristics of renal cell carcinoma (RCC) risk groups from JAVELIN Renal 101.

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 , John B. A. G. Haanen , James M. G. Larkin , Brian I. Rini , Laurence Albiges , Robert J. Motzer , Alessandra di Pietro , Xinmeng Jasmine Mu , Keith A. Ching , Subramanian Hariharan , Paul B. Robbins

Organizations

The Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, Netherlands Cancer Institute, Amsterdam, Netherlands, Royal Marsden NHS Foundation Trust, London, United Kingdom, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, Institut Gustave Roussy, Villejuif, France, Memorial Sloan Kettering Cancer Center, New York, NY, Pfizer SRL, Milan, Italy, Pfizer Inc., San Diego, CA, Pfizer Inc., New York, NY

Research Funding

Pharmaceutical/Biotech Company
This study was funded by Pfizer Inc., as part of an alliance between Pfizer Inc. and Merck KGaA, Darmstadt, Germany.

Background: The phase 3 JAVELIN Renal 101 trial in patients (pts) with advanced RCC demonstrated a progression-free survival (PFS) benefit and higher objective response rate (ORR) with avelumab + axitinib (A+Ax) vs sunitinib (S) (Motzer NEJM 2019). PFS and ORR favored A+Ax in all MSKCC risk groups, but median PFS varied. Here, we report results from analyses of baseline tumor samples to define molecular characteristics underlying risk group classifications. Methods: Nephrectomy or tumor samples from pts enrolled in the study were characterized by immunohistochemistry (CD8 and PD-L1), whole exome sequencing, or gene expression profiling (n = 705–850). Gene expression signatures (GES), pathway activation status, and mutational profiles were examined in relation to MSKCC risk groups. Results: Of the 886 total pts enrolled, 23%, 66%, and 11% had favorable (F), intermediate (I), or poor (P) MSKCC risk factors at baseline. In the F, I, and P groups, the ORR was 66%/38%, 50%/24%, and 31%/9%; median PFS was NR/16.7 mo, 13.3 mo/7.9 mo, and 5.6 mo/2.8 mo for the A+Ax/S arms, respectively. Neither the presence of PD-L1+ immune cells nor CD8+ cells differentiated the subgroups; however, the presence of PD-L1+ tumor cells was highest in the P group (p=0.0159). When compared to the I and P groups, the F group was enriched for NOTCH2 mutations (p=0.0002), displayed high FLT1 expression (p=0.007), and showed a trend favoring angiogenesis GES (JAVELIN Renal 101 and IMmotion150). The I group displayed few distinguishing characteristics (low neutrophil GES [p=0.02] and elevated homeobox gene expression [p=0.00052]). Relative to the F group, the P group showed higher cell cycle gene expression (p=0.0057) and PTEN mutation frequency, wild-type NOTCH2 genotype, elevated IMmotion150 Myeloid inflamed GES (p=0.0024), and macrophage-specific GES (p=0.0327), as well as GES for TH2 (p=0.0002), hypoxia (p=0.0199), glycolysis (p=0.0066), and the lowest expression of a dendritic cell GES (p=0.0209). Conclusions: In advanced RCC patients, biological differences within each MSKCC risk category may impact response to treatment and may help explain why these groups perform differently. Clinical trial information: NCT02684006

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Abstract Details

Meeting

2020 Genitourinary Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session C: Renal Cell Cancer

Track

Renal Cell Cancer

Sub Track

Tumor Biology, Biomarkers, and Pathology

Clinical Trial Registration Number

NCT02684006

Citation

J Clin Oncol 38, 2020 (suppl 6; abstr 744)

Abstract #

744

Poster Bd #

J20

Abstract Disclosures

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