Clinical activity of the RET inhibitor pralsetinib (BLU-667) in patients with RET fusion–positive solid tumors.

Authors

Vivek Subbiah

Vivek Subbiah

The University of Texas MD Anderson Cancer Center, Houston, TX

Vivek Subbiah , Mimi I-Nan Hu , Justin F. Gainor , Aaron Scott Mansfield , Guzman Alonso , Matthew H. Taylor , Viola Weijia Zhu , Pilar Garrido , Alessio Amatu , Robert C Doebele , Philippe Cassier , Bhumsuk Keam , Martin H. Schuler , Hui Zhang , Corinne Clifford , Michael Palmer , Jennifer Green , Christopher D. Turner , Giuseppe Curigliano

Organizations

The University of Texas MD Anderson Cancer Center, Houston, TX, Massachusetts General Hospital, Boston, MA, Mayo Clinic, Rochester, MN, Vall d' Hebron Institute of Oncology (VHIO), Vall d’ Hebron Hospital Universitari, Barcelona, Spain, Earle A. Chiles Research Institute, Portland, OR, University of California, Irvine School of Medicine, Orange, CA, IRYCIS. Hospital Universitario Ramón y Cajal, Madrid, Spain, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy, University of Colorado Cancer Center, Aurora, CO, Centre Léon Bérard, Lyon, France, Seoul National University Hospital, Seoul, South Korea, Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany, Blueprint Medicines Inc, Cambridge, MA, Blueprint Medicines, Cambridge, MA, European Institute of Oncology, IRCCS, University of Milano, Milan, Italy

Research Funding

Pharmaceutical/Biotech Company
Blueprint Medicines Inc.

Background: Recent tumor-agnostic drug approvals have resulted in a paradigm shift in cancer treatment away from organ/histology specific indications to biomarker-guided tumor-agnostic approaches. Pralsetinib is a potent and selective RET inhibitor, which has recently been approved by the U.S. Food and Drug Administration (FDA) for the treatment of adults with metastatic RET fusion–positive non-small cell lung cancer (NSCLC) and is under New Drug Application review for RET mutant thyroid cancers by the FDA. RET fusions occur in up to approximately 7‒8% of patients with gastrointestinal malignancies, including pancreatic, liver, and colorectal cancers. There are currently no approved selective RET inhibitors for patients with RET fusion–positive solid tumors other than NSCLC and thyroid cancer. Here, we present data on the clinical activity of pralsetinib in patients with RET fusion–positive solid tumor types other than NSCLC enrolled in the Phase I/II ARROW study (NCT03037385). Methods: ARROW consists of a phase I dose escalation (30–600 mg once [QD] or twice daily) followed by a phase II expansion (400 mg QD) in patients with advanced RET-altered solid tumors. Primary objectives are overall response rate (ORR), per RECICT v1.1 and safety. Results: A total of 13 patients with RET fusion–positive thyroid cancer (12 papillary, 1 poorly differentiated; enrollment cutoff July 11, 2019) and 14 patients with RET fusion–positive solid tumors other than NSCLC and thyroid (3 pancreatic, 3 colon, 2 cholangiocarcinoma, 6 other; enrollment cutoff November 19, 2019) were enrolled in ARROW and received pralsetinib. At the February 13, 2020, data cutoff, the ORR (blinded central review) in response-evaluable patients with RET fusion–positive thyroid cancer was 91% (10/11; 95% CI: 59‒100) and disease control rate was 100% (95% CI: 72‒100). Treatment was ongoing in 7 of 11 patients. In RET fusion–positive solid tumors other than NSCLC and thyroid, ORR (investigator’s assessment) was 50% (6/12; 95% CI: 21‒79) and responses were observed in all patients with pancreatic cancer (3/3) and cholangiocarcinoma (2/2). Treatment was ongoing in 6 of 12 patients, including 2 of 3 patients with pancreatic cancer and 1 of 2 patients with cholangiocarcinoma. Responses were observed across multiple fusion genotypes. In the 27 patients with RET fusion–positive tumors other than NSCLC, most frequent treatment-related adverse events (TRAEs) were grade 1–2, and included anemia (33%), increased aspartate aminotransferase (33%), decreased white blood cell count (33%), hypertension (30%), increased alanine aminotransferase (26%), hyperphosphatemia (19%), and neutropenia (19%). No patients discontinued due to TRAEs. Conclusions: Pralsetinib demonstrated broad and durable antitumor activity across multiple advanced solid tumor types, regardless of RET fusion genotype, and was well tolerated. The study is ongoing. Clinical trial information: NCT03037385

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Abstract Details

Meeting

2021 Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session: Other GI Cancer

Track

Other GI Cancer

Sub Track

Therapeutics

Clinical Trial Registration Number

NCT03037385

Citation

J Clin Oncol 39, 2021 (suppl 3; abstr 467)

DOI

10.1200/JCO.2021.39.3_suppl.467

Abstract #

467

Poster Bd #

Online Only

Abstract Disclosures

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