Safety profile of ripretinib, including impact of alopecia, and Palmar-Plantar Erythrodysesthesia Syndrome (PPES) on patient-reported outcomes (PROs), in ≥ fourth-line advanced gastrointestinal stromal tumors (GIST): Analyses from INVICTUS.

Authors

null

Suzanne George

Dana-Farber Cancer Institute, Boston, MA

Suzanne George , Michael C. Heinrich , John Raymond Zalcberg , Sebastian Bauer , Hans Gelderblom , Patrick Schoffski , Cesar Serrano , Robin L. Jones , Steven Attia , Gina Z. D'Amato , Ping Chi , Peter Reichardt , Mario E. Lacouture , Elva Cha , Julie Nicole Meade , Rodrigo Ruiz-Soto , Jean-Yves Blay , Margaret von Mehren

Organizations

Dana-Farber Cancer Institute, Boston, MA, Portland VA Health Care System and OHSU Knight Cancer Institute, Oregon Health & Science University, Portland, OR, School of Public Health and Preventative Medicine, Monash University, and Alfred Health, Melbourne, Australia, West German Cancer Center, Essen University Hospital, University of Duisburg-Essen, Essen, Germany, Leiden University Medical Center, Leiden, Netherlands, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium, Vall d’Hebron Institute of Oncology, Barcelona, Spain, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom, Mayo Clinic, Jacksonville, FL, Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY, HELIOS Klinikum Berlin-Buch, Berlin, Germany, Memorial Sloan Kettering Cancer Center, New York, NY, Deciphera Pharmaceuticals, LLC, Waltham, MA, Deciphera Pharmaceuticals, Inc, Waltham, MA, Centre Léon Bérard, Unicancer, Lyon, France, Fox Chase Cancer Center, Philadelphia, PA

Research Funding

Pharmaceutical/Biotech Company
Deciphera, LLC.

Background: Ripretinib is a novel switch-control TKI that broadly inhibits KIT and PDGFRA kinase signaling. In INVICTUS (NCT03353753), a randomized, double-blind, placebo (PBO)-controlled trial of ripretinib in ≥4th-line advanced GIST, ripretinib reduced the risk of disease progression or death by 85% vs PBO with a favorable overall safety profile. Common ( > 20%) adverse events (AEs) included, but were not limited to, alopecia and PPES. Exploratory analyses evaluated the impact of alopecia and PPES on quality of life (QoL). Methods: Patients (pts) with advanced GIST previously treated with at least imatinib, sunitinib, and regorafenib were randomized (2:1) to ripretinib 150 mg QD or PBO. AEs were graded using CTCAE v4 and PROs collected using EQ-5D-5L (EQ5D) and EORTC QLQ-C30 (C30). Repeated measures (RM) models assessed the impact of alopecia and PPES on 5 PROs (EQ5D visual analogue scale; and C30 physical functioning, role functioning, and the overall health and overall QoL questions) within the ripretinib arm. Fixed effects were sex, alopecia/PPES, and ECOG scores at baseline. Results: 128/129 randomized pts received treatment (85 ripretinib 150 mg QD; 43 PBO). Alopecia, regardless of causality, occurred in 44 (51.8%) on ripretinib (34 [40.0%] grade 1; 10 [11.8%] grade 2) and 2 (4.7%) on PBO (both grade 1). PPES occurred in 18 (21.2%) on ripretinib (11 [12.9%] grade 1; 7 [8.2%] grade 2); none on PBO. The median times in days to first occurrence and worst severity grade with ripretinib were 57.0 and 62.5 for alopecia; 56.5 and 57.0 for PPES. The RM models showed a slight trend towards improvement in PRO score over time for pts with alopecia; the only association reaching a P-value of < 0.05 was between alopecia and increased overall QoL. None of the associations between PPES and PRO scores reach P < 0.05. All PRO p-values are nominal, and no statistical significance is being claimed. Conclusions: Ripretinib had a favorable overall safety and tolerability profile. When stratified by alopecia and PPES, patient-reported assessments of function, overall health, and overall QoL were maintained over time. For both alopecia and PPES, onset and maximum severity occurred almost simultaneously, indicating that these events generally did not progressively worsen. These results suggest that alopecia and PPES are manageable and do not have a negative effect on function, overall health, and QoL. Clinical trial information: NCT03353753.

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Abstract Details

Meeting

2020 ASCO Virtual Scientific Program

Session Type

Poster Session

Session Title

Sarcoma

Track

Sarcoma

Sub Track

Gastrointestinal Stromal Tumors (GIST)

Clinical Trial Registration Number

NCT03353753

Citation

J Clin Oncol 38: 2020 (suppl; abstr 11539)

DOI

10.1200/JCO.2020.38.15_suppl.11539

Abstract #

11539

Poster Bd #

427

Abstract Disclosures