A phase II, multicenter, single-arm trial of eribulin in patients with bevacizumab-resistant recurrent glioblastoma.

Authors

Masamichi Takahashi

Masamichi Takahashi

Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan

Masamichi Takahashi , Satoshi Kawashima , Yohei Otake , Natsuko Satomi-Tsushita , Aya Kuchiba , Ryo Sadachi , Keiko Ohata , Hitoshi Ozawa , Kan Yonemori , Motoo Nagane , Yoshiki Arakawa , Akitake Mukasa , Shota Tanaka , Ryo Nishikawa , Yoshihiro Muragaki , Kenkichi Masutomi , Koichi Ichimura , Kenichi Nakamura , Yoshitaka Narita

Organizations

Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan, Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan, National Cancer Center Hospital, Tokyo, Japan, Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan, Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan, Department of Neurosurgery, Kumamoto University, Kumamoto, Japan, Department of Neurosurgery, The University of Tokyo, Tokyo, Japan, Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan, Tokyo Women’s Medical University Hospital, Shinjyuku-ku, Tokyo, Japan, Division of Cancer Stem Cell, National Cancer Center Research Institute, Tokyo, Japan, Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan

Research Funding

Other Government Agency

Background: Glioblastoma (GBM) is one of the worst prognostic cancers and there is no effective treatment after failure of bevacizumab. Eribulin is a microtubule inhibitor used for the treatment of patients with metastatic breast cancer and liposarcoma. We previously reported that eribulin strongly inhibits the RNA-dependent RNA polymerase (RdRP) activity of TERT protein in cancer cells, and has a strong anti-tumor effect against GBM cells with TERT promoter mutation. In this study we aim to investigate the efficacy and safety of eribulin in patients with bevacizumab-resistant recurrent GBM. Methods: This is an open-label, multicenter, single-arm phase II trial. Eligible patients aged 20-75 years with bevacizumab-resistant recurrent GBM were enrolled from 2018-2020. Patients received eribulin 1.4 mg/m2 on days 1 and 8 of 21-day cycle until disease progression or intolerable toxicity was observed. The primary endpoint was one-year overall survival rate (1yOS%). The 35 patients are needed to achieve an 80% power at a one-sided alpha of 10%, under threshold 1yOS% of 10% and expected 1yOS% of 25%. Results: Thirty-seven patients aged 26-73 (median: 54) years were treated. Twenty-six of 37 (70.3%) patients were diagnosed as IDH-wildtype GBM, 4 (10.8%) were with IDH-mutant GBM and 7 (18.9%) were GBM, NOS. Thirty-four (91.9%) patients had a Karnofsky performance status of 70 or 80 at the registration. Thirty-one (83.8%) patients received additional treatments, including 28 (75.7%) bevacizumab, 11 (29.7%) re-irradiation and 3 (8.1%) resection after failure of eribulin. Among 37 subjects, 32 surgical specimens were analyzed for TERT promoter mutation and 15 for RdRP activity. 1yOS% was 29.7% [80% CI: 20.5 to 39.5 (p < 0.0001), 95% CI: 16.1 to 44.6]. Median OS was 9.0 months [95% CI: 6.2 to 11.0] and median progression-free survival was 1.5 months [95% CI: 1.4 to 1.7]. Neither TERT nor RdRP statuses was associated with prolonged OS. Among all the target lesions evaluated, two lesions decreased more than 50% in size and the patients survived more than one year, however no obvious PR was confirmed at the final evaluation. The disease control rate was 25.7% [95% CI: 12.5 to 43.3]. Common ≥ grade 2 AEs were neutropenia (70.3%), leukopenia (56.8%), lymphopenia (27.0%), elevation of γ-GTP (13.5%), elevation of ALT (10.8%), elevation of AST (8.1%), alopecia (8.1%). Treatment-related grade 3 or 4 AEs occurred in 59.5% of subjects. There were no AEs leading to death. Conclusions: Eribulin was safely applied for the patients with recurrent GBM. This phase II study met its primary endpoint of 1yOS%, although no obvious response was observed. Further investigation to reveal the biomarkers related to longer survival is underway. Clinical trial information: UMIN000030359.

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Abstract Details

Meeting

2022 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Central Nervous System Tumors

Track

Central Nervous System Tumors

Sub Track

Primary CNS Tumors–Glioma

Clinical Trial Registration Number

UMIN000030359

Citation

J Clin Oncol 40, 2022 (suppl 16; abstr 2036)

DOI

10.1200/JCO.2022.40.16_suppl.2036

Abstract #

2036

Poster Bd #

374

Abstract Disclosures

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