Mayo Clinic, Jacksonville, FL
Steven Attia , Victor Manuel Villalobos , Nadia Hindi , Brian Andrew Van Tine , Andrew J. Wagner , Bartosz Chmielowski , Donna Elise Levy , Matteo Ceccarelli , Robin Lewis Jones , Mark Andrew Dickson
Background: Doxorubicin (doxo) remains standard first-line therapy for advanced STS. Doxo in combination with olaratumab (O) demonstrated superior clinical activity compared to doxo alone in a Ph 2 trial (NCT01185964), although this was not confirmed in the subsequent Ph 3 trial (NCT02451943). Gemcitabine (G) plus docetaxel (D) is a second line therapy for advanced STS. Here, we report a concurrent Ph 2 study that explored a second-line addition of O to G and D for advanced STS (ANNOUNCE 2 NCT02659020). Methods: Adult patients (pts) with unresectable locally advanced or metastatic STS, ≤ 2 prior lines of systemic therapy, and ECOG PS 0-1 were eligible. Pts were enrolled from 2 cohorts: O-naïve and O-pretreated. In both cohorts, pts were randomized 1:1 to either O, G plus D or placebo (PBO), G plus D. Pts received 21-day cycles of O (20 mg/ kg cycle 1 and 15 mg/kg other cycles, day (d) 1 and d8), G (900 mg/m2, d1 and d8) and D (75 mg/m2, d8). Pts continued treatment until progression, toxicity, or withdrawal. Randomization was stratified by histology (leiomyosarcoma [LMS] vs non-LMS), prior systemic therapy, ECOG PS, and prior pelvic radiation. The primary objective was overall survival (OS) in the O-naïve population using an alpha level of 0.20. Secondary endpoints included OS (O-pretreated) and other efficacy parameters, as well as safety and pharmacokinetics (PK). Results: 167 pts were enrolled in the O-naïve cohort and 89 pts in the O-pretreated cohort. Baseline patient characteristics were well balanced. OS for O-naïve pts was 16.8 vs 18.0 months (m) (hazard ratio [HR] = 0.95, 95% CI: 0.64-1.40; p = 0.78) for the investigational vs control arm, respectively. Other efficacy outcomes are presented in the table. Safety was manageable across treatment arms. PK parameter estimates for O were consistent with previous studies. Conclusions: There was no statistically significant difference in OS between the two arms in the O-naïve population. However, while not statistically significant, the combination of O, G and D demonstrated favorable OS in the O-pretreated cohort, and PFS and objective response rate (ORR) in both cohorts. For O-naïve pts, a clinically meaningful progression-free survival (PFS) improvement was observed. Further investigations in specific histological subtypes are ongoing. Clinical trial information: NCT02659020
Cohort | O-Naïve | O-Pretreated | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
O+G+D N = 81 | Control N = 86 | HR (95% CI)/ p-value* | O+G+D N = 46 | Control N = 43 | HR (95% CI)/ p-value* | |||||
Endpoint | 95% CI | 95% CI | 95% CI | 95% CI | ||||||
OS, median m | 16.8 | 15.3, 25.4 | 18.0 | 13.2, 22.9 | 0.95 (0.64, 1.40)/0.78 | 19.8 | 14.2, - | 17.3 | 10.8, 20.3 | 0.67 (0.39, 1.16)/0.15 |
PFS, median m | 7.6 | 5.1, 8.5 | 4.4 | 2.9, 6.9 | 0.69 (0.48, 1.01)/0.06 | 5.5 | 2.8, 8.7 | 4.2 | 2.2, 6.9 | 0.83 (0.49, 1.40)/0.48 |
ORR, % | 32.1 | 22.2, 43.4 | 23.3 | 14.8, 33.6 | 0.19 | 30.4 | 17.7, 45.8 | 14 | 5.3, 27.9 | 0.06 |
CI = confidence interval; N = total number of pts *Log-rank p-value (2-sided).
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