MD Anderson Cancer Center Madrid, Madrid, Spain
Enrique Grande , Félix Guerrero , Javier Puente , Isabel Galante , Ignacio Duran , Mario Dominguez , Teresa Alonso Gordoa , Javier Burgos , Albert Font , Alvaro Pinto , Mario Alvarez-Maestro , Oscar Reig , José Maroto , Xavier Garcia del Muro , Patricia Galvan , Juan Fernando Garcia , Nuria Malats , Aleix Prat , Francisco X. Real , Daniel Castellano
Background: Cisplatin-based neoadjuvant chemotherapy (CT) followed by radical cystectomy (RC) is a standard treatment for MIBC. PD-1/L1 inhibitors as single agent induce pathological complete responses (pCR) in this setting. Predictors of response are still ill defined. DUTRENEO trial aimed to prospectively explore the activity of anti-PDL1 + anti-CTLA4 vs CT in pts selected according to a tumor pro-inflammatory IFN-gamma signature (tumor immune score, TIS). Methods: Cisplatin-eligible pts with urothelial MIBC (cT2-T4a, N≤1, M0) candidates to RC were classified as “hot” or “cold” according to a tumor TIS determined by Nanostring technology. Patients with "hot" tumors were randomized to DU 1500 mg + TRE 75 mg every 4 weeks x 3 cycles or standard cisplatin-based CT (GEMCIS or MVACdd). Pts in the “cold” arm received standard CT. Primary endpoint was to achieve ≥8 pCR in the DU+TRE arm. PDL1 expression was assessed using immunohistochemistry. Results: 61 pts were recruited in 10 sites between oct-2018 and dec-2019. Pts randomized in the “hot” arms received standard CT (n = 22) or DU+TRE (n = 23) and had a pCR rate of 8/22 pts (36.4%) vs 8/23 pts (34.8%), respectively [OR = 0.923 (0.26 – 3.24)]. In the “cold” arm, 16 pts received CT obtaining a pCR rate of 68.8% (11/16 pts). There were more PDL1 low tumors in the "cold" TIS arm (10/12, 83.3%). pCR rate by PDL1 status is shown in the table. One pt in the DU+TRE arm refused RC. Full treatment was delivered to 81.3% of CT "cold" vs 59.1% of CT "hot" vs 73.9% in the DU+TRE arm pts. Grade 3-4 toxicities were more frequent in the CT arms. Conclusions: The combination of DU+TRE is safe and active in MIBC patients in the neoadjuvant setting. Nevertheless prospective stratification by a pro-inflammatory IFN-gamma signature failed to select patients more likely to benefit from IO vs CT in this context. Further studies are required to guide treatment selection. Clinical trial information: NCT03472274.
COLD: CT (N = 16) | HOT: CT (N = 22) | HOT: DU+TRE (N = 23) | |
---|---|---|---|
Pathologic complete response | 11 (68.8%) | 8 (36.4%) | 8 (34.8%) |
Progressive disease | 0 (0.0%) | 2 (9.1%) | 1 (4.3%) |
pCRs in PDL1 high (%) | 50.0% | 60.0% | 57.1% |
pCRs in PDL1 low (%) | 90.0 | 60.0% | 14.3% |
Completed cystectomy | 15 (93.8%) | 20 (90.9%) | 20 (87.0%) |
Grade 3-4 toxicities | 10 (62.5%) | 8 (36.4%) | 5 (21.7%) |
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Abstract Disclosures
2019 ASCO Annual Meeting
First Author: Enrique Grande
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