Phase I dose escalation and expansion study of defactinib, pembrolizumab, and gemcitabine in patients with advanced treatment-refractory pancreatic cancer.

Authors

Andrea wang-gillam

Andrea wang-gillam

Washington University School of Medicine in St. Louis, St. Louis, MO

Andrea wang-gillam , Kian-Huat Lim , Robert R. McWilliams , Rama Suresh , A. Craig Lockhart , Amberly Brown , John Herndon , Katrina Sophia Pedersen , Benjamin R. Tan Jr., Nicolas Boice , Mina Abdiannia , Feng Gao , Harry H. Yoon , Mojun Zhu , Nikolaos A. Trikalinos , Lee Ratner , Olivia Aranha , William G. Hawkins , Brett Herzog , David G. DeNardo

Organizations

Washington University School of Medicine in St. Louis, St. Louis, MO, Mayo Clinic, Rochester, MN, Medical University of South Carolina, Charleston, SC

Research Funding

U.S. National Institutes of Health
Pharmaceutical/Biotech Company

Background: Targeting focal adhesion kinase (FAK) renders checkpoint immunotherapy effective in pancreatic ductal adenocarcinoma (PDAC) mouse models. Defactinib is a highly potent oral FAK inhibitor shown to have a tolerable safety profile. We evaluated the safety and recommended phase 2 dose (RP2D) of defactinib in combination with pembrolizumab and gemcitabine for PDAC patients. Methods: We conducted a multicenter, open-label, phase I study with dose escalation and expansion phases. In 3x3 dose escalation, patients with refractory solid tumors were treated at five escalating dose levels of defactinib and gemcitabine to identify a RP2D. In expansion phase, patients with metastatic PDAC who progressed on frontline treatment (refractory cohort) or had treatment response or stable disease (SD) on standard gemcitabine/nab-paclitaxel (maintenance cohort) were treated at RP2D. Pre- and post-treatment tumor biopsies were performed to evaluate changes in tumor immunity. Results: The triple drug combination was well-tolerated with no dose-limiting toxicities. Among 17 treated patients with refractory PDAC, the disease control rate (DCR) was 58.8% with one partial response (PR) and nine SDs and the median progression-free survival (PFS) and overall survival (OS) were 4.2 months and 9.1 months, respectively. Among the evaluable patients in the maintenance cohort, DCR was 63.6% with one PR and six SD. Three patients with SD came off study due to treatment- or disease-related complications. The median PFS and OS were 5.0 months and 8.3 months, respectively. Conclusions: The combination of defactinib, pembrolizumab, and gemcitabine was well-tolerated, had promising preliminary efficacy, and showed increased infiltrative T lymphocytes in post-treatment tumor biopsies. Incorporation of a more potent chemotherapy backbone should be considered to achieve better clinical response in future trial design. Clinical trial information: NCT02546531.

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Abstract Details

Meeting

2022 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Track

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Sub Track

Pancreatic Cancer

Clinical Trial Registration Number

NCT02546531

Citation

J Clin Oncol 40, 2022 (suppl 16; abstr 4146)

DOI

10.1200/JCO.2022.40.16_suppl.4146

Abstract #

4146

Poster Bd #

131

Abstract Disclosures

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