Effects of baseline lactate dehydrogenase (LDH), interferon gamma (IFN-g) expression, and tumor mutational burden (TMB) on treatment response to first-line atezolizumab (A) + vemurafenib (V) and cobimetinib (C) in BRAFV600 mutation–positive advanced melanoma.

Authors

null

Caroline Robert

Gustave Roussy and Université Paris-Saclay, Villejuif-Paris, France

Caroline Robert , Karl D. Lewis , Paolo Antonio Ascierto , Rodrigo Ramella Munhoz , Gabriella Liszkay , Luis de la Cruz-Merino , Judit Olah , Paola Queirolo , Jacek Mackiewicz , Ivor Caro , Kalpit Shah , Harper Forbes , Haocheng Li , Christian Hertig , Yibing Yan , Edward Francis Mckenna Jr., Ralf Gutzmer , Grant A. McArthur

Organizations

Gustave Roussy and Université Paris-Saclay, Villejuif-Paris, France, University of Colorado Comprehensive Cancer Center, Aurora, CO, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil, Országos Onkológiai Intézet, Budapest, Hungary, Hospital Universitario Virgen Macarena, Seville, Spain, University of Szeged Szent-Györgyi Medical University, Szeged, Hungary, IRCCS Istituto Europeo di Oncologia, Milan, Italy, Department of Diagnostics and Cancer Immunology, Greater Poland Cancer Centre, Poznan, Poland, Genentech, Inc., South San Francisco, CA, Hoffmann La-Roche Ltd., Mississauga, ON, Canada, F. Hoffmann-La Roche Ltd., Basel, Switzerland, Haut-Tumour-Zentrum Hannover (HTZH), Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover (MHH), Hannover, Germany, Melanoma and Skin Service and Cancer Therapeutics Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

Research Funding

Pharmaceutical/Biotech Company
F. Hoffmann-La Roche

Background: The phase 3 IMspire150 study showed that first-line A+V+C improved investigator-assessed PFS vs placebo (P)+V+C in BRAFV600E/K mutation–positive advanced melanoma (hazard ratio 0.78; P=.0249). Prior biomarker analyses showed that IFN-g or TMB > 10 mut/Mb were associated with greater PFS benefits with A+V+C (Lewis et al. J ImmunoTher Cancer 2020;8:A188-A189). We further evaluated the association of these biomarkers with outcomes. Methods: Exploratory recursive partitioning analysis (RPA) was used to model associations between PFS and age ( < 65 vs ≥65 y), Eastern Cooperative Oncology Group performance status (0 vs 1), liver metastases (yes vs no), metastatic sites (≤3 vs > 3), sum of longest tumor diameters ( < 44 mm vs ≥44 mm), baseline LDH (normal [n] vs elevated [e]), TMB ( < 10 vs ≥10 mut/Mb), PD-L1 (negative vs positive), and IFN-g (high [h; > Quartile 3; Q3] vs intermediate [ > Q1 and ≤Q3] vs low [≤Q1]). Time-to-event analyses were summarized using Kaplan-Meier estimates. Results: The RPA analysis included 208/256 (81.3%) patients (pts) from the A+V+C arm of IMspire150 for whom LDH, TMB, IFN-g, and PD-L1 data were available. RPA showed that LDH was associated with PFS. In pts treated with A+V+C and n-LDH, h-IFN-g signature was associated with longer PFS and higher rates of objective response (OR) and complete response (CR) vs low/intermediate (l/i) IFN-g (2-y PFS: 59% vs 38%; ORR: 77% vs 69%; CR: 38% vs 15%, respectively); TMB ≥10 mut/Mb was associated with more favorable outcomes in pts with e-LDH (Table). In contrast, neither IFN-g nor TMB discriminated PFS outcomes in n-LDH or e-LDH pt subgroups receiving P+V+C. Pts with e-LDH and TMB < 10 mut/Mb had poor PFS outcomes, with 2-y PFS rates of 9% and 3% and lower rates of OR (51% and 62%) and CR (5% and 9%) in the A+V+C and P+V+C arms, respectively. Similar trends were observed for duration of response (DOR), and for the subset of pts with BRAFV600E mutation–positive melanoma. A+V+C improved PFS vs P+V+C across all subgroups with the exception of e-LDH and TMB < 10. Conclusions: IFN-g and TMB discriminated PFS benefit in pts receiving A+V+C but not for those receiving P+V+C. Durable responses were observed for pts treated with A+V+C in the n-LDH + h-IFNg subgroups.

n-LDH + h-IFN-gamma
n-LDH + l/i-IFN-gamma
e-LDH + TMB ≥10e-LDH + TMB < 10
A+V+C, n261103537
Median PFS, mo (95% CI)Not estimable (NE; 15.3-NE)16.6 (11.1-23.0)11.4 (6.2-NE)5.6 (4.3-10.6)
Median DOR, mo (95% CI)NE (16.8-NE)20.4 (14.8-NE)14.8 (10.4-NE)9.0 (4.5-NE)
P+V+C, n47943232
Median PFS, mo (95% CI)12.9 (10.1-18.9)12.5 (9.5-21.3)7.3 (5.6-16.9)7.6 (6.1-11.1)
Median DOR, mo (95% CI)12.0 (9.4-NE)18.7 (11.1-NE)14.5 (7.7-NE)7.7 (5.7-14.5)

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Poster Discussion Session

Session Title

Melanoma/Skin Cancers

Track

Melanoma/Skin Cancers

Sub Track

Biologic Correlates

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr 9523)

DOI

10.1200/JCO.2021.39.15_suppl.9523

Abstract #

9523

Abstract Disclosures