Exposure-response (E-R) efficacy and safety (E-S) analyses of tremelimumab as monotherapy or in combination with durvalumab in patients (pts) with unresectable hepatocellular carcinoma (uHCC).

Authors

null

Xuyang Song

AstraZeneca, Gaithersburg, MD

Xuyang Song , Robin Kate Kelley , Anis Khan , Nathan Standifer , Rajesh Krishna , Lucy Liu , Kun Wang , Michelle Green , Patricia McCoon , Alejandra Negro , Philip He , Rajesh Narwal , Ghassan K. Abou-Alfa

Organizations

AstraZeneca, Gaithersburg, MD, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, AstraZeneca, San Francisco, CA, Certara, Princeton, NJ, Shanghai Qiangshi Information Technology, Shanghai, China, Certara Strategic Consulting, Menlo Park, CA, Cancer Bioscience, AstraZeneca Research and Development, Boston, MA, Memorial Sloan Kettering Cancer Center, New York, NY

Research Funding

Pharmaceutical/Biotech Company
AstraZeneca.

Background: In a phase II study in uHCC (Study 22, NCT02519348), a novel, priming combination regimen of tremelimumab (T; anti-CTLA-4) and durvalumab (D; anti-PD-L1) (T300+D) has shown favorable clinical activity vs each agent as monotherapy or vs another combination (T75+D). The analyses presented here assess the pharmacokinetics (PK) and relationships between tremelimumab exposure, as monotherapy or in combination, and safety, efficacy, and pharmacodynamics (PD) in this study. Methods: Overall, 216 pts were included in these analyses (T, n=65; T300+D, n=72; T75+D, n=79). Safety, antitumor activity, PK, PD, and immunogenicity were analyzed using standard pharmacometrics methods. A previously developed population PK model for T across solid tumors was validated using T monotherapy and combination therapy data from Study 22, including a post-hoc covariate analysis to assess the impact of covariates on individual PK parameters. Population PK and PD models related individual T exposures to safety parameters, PD, and efficacy (overall survival, OS; progression-free survival, PFS; and objective response rate, ORR). The E-R relationships for time-to-event variables OS and PFS were explored by Kaplan-Meier estimates and analyzed by Cox proportional-hazards models (CPHM). Results: For T monotherapy and T+D combinations, no significant E-S relationships were observed for grade 3/4 treatment-related adverse events (TRAEs), grade 3/4 TRAEs of special interest, and AEs leading to treatment discontinuation. Analyses of each quartile of T exposure suggest pts with higher exposure (3rd and 4th quartile) may have longer OS vs lower quartiles. The CPHManalysis showed that after accounting for prognostic factors (baseline albumin and neutrophil-to-lymphocyte ratio), neither AUC nor Cmin appeared to be a significant factor for OS hazard. There was no significant relationship between response and ORR, PFS and any T PK exposure metric in T-treated pts. Saturable relationships (described by Emax) were observed for maximum change from baseline for proliferating T-cell counts as functions of exposure. Conclusions: The observed PK data are generally consistent with predictions based on a historical population PK model, suggesting the PK of T in uHCC pts is consistent with pts with other solid tumors. No significant relationships were observed between E-S and E-R; therefore, PK is not a significant predictor to evaluate for T efficacy or safety. Considering the small sample size limitation, still the saturable relationships observed in proliferating T-cells appear to support a dose of T300. Future studies of pooled data from Study 22 and the larger phase III HIMALAYA study (NCT03298451) will be conducted to further the characterization of E-R relationships and the development of the T300+D regimen. Clinical trial information: NCT02519348

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Abstract Details

Meeting

2021 Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session: Hepatobiliary Cancer

Track

Hepatobiliary Cancer

Sub Track

Therapeutics

Clinical Trial Registration Number

NCT02519348

Citation

J Clin Oncol 39, 2021 (suppl 3; abstr 313)

DOI

10.1200/JCO.2021.39.3_suppl.313

Abstract #

313

Poster Bd #

Online Only

Abstract Disclosures