Neoadjuvant talazoparib in patients with germline BRCA1/2 (gBRCA1/2) mutation-positive, early HER2-negative breast cancer (BC): Results of a phase 2 study.

Authors

null

Jennifer Keating Litton

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

Jennifer Keating Litton , Joseph Thaddeus Beck , Jason M. Jones , Jay Andersen , Joanne Lorraine Blum , Lida A. Mina , Raymond Brig , Michael A. Danso , Yuan Yuan , Antonello Abbattista , Kay Noonan , Jayeta Chakrabarti , Akos Czibere , William Fraser Symmans , Melinda L. Telli

Organizations

The University of Texas MD Anderson Cancer Center, Houston, TX, Highlands Oncology Group, Springdale, AR, Avera Cancer Institute, Sioux Falls, SD, Compass Oncology, West Cancer Center, Tigard, OR, Texas Oncology–Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas, TX, Banner MD Anderson Cancer Center, Gilbert, AZ, Brig Center for Cancer Care and Survivorship, Knoxville, TN, Virginia Oncology Associates, Norfolk, VA, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, Pfizer Oncology, Milan, Italy, Pfizer Inc., Groton, CT, Pfizer Inc., Walton Oaks, United Kingdom, Pfizer Inc., Cambridge, MA, Stanford University School of Medicine, Stanford, CA

Research Funding

Pharmaceutical/Biotech Company
Pfizer.

Background: Talazoparib (TALA) is a poly(ADP-ribose) polymerase inhibitor approved as monotherapy for treating adult patients (pts) with gBRCA1/2-mutated HER2-negative locally advanced or metastatic BC. Methods: This phase 2, non-randomized, single-arm, open-label study (NCT03499353) evaluated the efficacy and safety of TALA in the neoadjuvant setting for pts with early gBRCA1/2-mutated HER2− BC. Primary endpoint was evaluation of pathologic complete response (pCR) as assessed by Independent Central Review (ICR) after completing 24 weeks of neoadjuvant TALA monotherapy 1 mg QD (0.75 mg for moderate renal impairment) followed by surgery. Secondary endpoints included pCR by investigator (INV) and residual cancer burden (RCB) by ICR (RCB: 0 [pCR], I [minimal], II [moderate], III [extensive]). The evaluable population included pts who received at least 80% of the TALA dose prescribed at treatment start and underwent breast surgery and pCR assessment, plus those who progressed before pCR could be assessed. The intent-to-treat (ITT) population included all pts who received at least 1 dose of TALA. Results: Of 61 pts treated with TALA (ITT and safety populations), 48 comprised the evaluable population. All pts had triple-negative BC. 60 pts had adenocarcinoma and 1 had squamous cell histology, with the following staging: I=20, II=27, III=14. Mean age was 44.6 years, mean duration of 4.5 wks since disease onset, mean duration of treatment of 23.3 wks, and mean overall relative dose intensity of 84.5% (ITT population). pCR (assessed by ICR and INV) and RCB (by ICR) for the evaluable and ITT populations are shown in the table below. Ten (16.4%) patients discontinued treatment due to progressive disease. One pt had a disruption of treatment as a result of COVID-19 restrictions, 2 pts for other reasons: to undergo surgery early and consent withdrawal; 9 patients received <80% dose. Treatment-emergent adverse events (AEs) were reported in 98.4% of pts (27.9% grade [G] 1, 23.0% G2, 45.9% G3, 1.6% G4); the most common were fatigue (78.7%; G1 54.1%; G2 21.3%; G3 3.3%), nausea (68.9%; G1 54.1%; G2 13.1%; G3 1.6%), and alopecia (57.4%; G1 54.1%; G2 3.3%). Three (4.9%) pts discontinued treatment due to AEs (G3 anemia [n=2] and G3 vertigo [n=1]) and continued on study. Conclusions: TALA monotherapy in the neoadjuvant setting was active and showed pCR rates comparable to those observed with combination anthracycline and taxane-based chemotherapy regimens and was generally well tolerated. Clinical trial information: NCT03499353

Evaluable population

(N=48)
ITT population

(N=61)
pCR by ICR, n (%) [95% CI]
22 (45.8) [32.0, 60.6]
30 (49.2) [36.7, 61.6]
pCR by INV, n (%) [95% CI]
22 (45.8) [32.0, 60.6]
29 (47.5) [35.0, 60.1]
RCB by ICR, n (%) [95% CI]


RCB 0
22 (45.8) [30.0, 62.6]
30 (49.2) [34.0, 64.5]
RCB I
0
1 (1.6) [0.2, 12.1]
RCB II
15 (31.3) [18.0, 48.5]
17 (27.9) [16.1, 43.7]
RCB III
0
0
Missing
11 (22.9) [11.8, 39.8]
13 (21.3) [11.2, 36.7]

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Oral Abstract Session

Session Title

Breast Cancer—Local/Regional/Adjuvant

Track

Breast Cancer

Sub Track

Neoadjuvant Therapy

Clinical Trial Registration Number

NCT03499353

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr 505)

DOI

10.1200/JCO.2021.39.15_suppl.505

Abstract #

505

Abstract Disclosures