Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY
Wungki Park , Catherine O'Connor , Joanne F. Chou , Carly Schwartz , Anna M. Varghese , Mary Larsen , Fiyinfolu Balogun , Robin Brenner , Kenneth H. Yu , Erin Diguglielmo , Shigeaki Umeda , Elias Karnoub , Fergus Keane , Haochen Zhang , Smita Suhas Joshi , Nadeem Riaz , David Paul Kelsen , Marinela Capanu , Christine A Iacobuzio-Donahue , Eileen Mary O'Reilly
Background: Maintenance olaparib improves PFS in gBRCA1/2m (core HRD) in mPDAC (Golan, NEJM 2019). Whether other HRD indicators, such as gene mutations other than gBRCA1/2m (non-Core HRD, Cohort B) and exceptional platinum responders (Cohort C, response > 6 months) may benefit from PARPi in mPDAC remains unanswered. We hypothesized that pembrolizumab and olaparib (POLAR) combination may improve outcome by immunogenic cell death. Methods: We conducted an open-label, non-randomized, phase 2 trial of POLAR as maintenance therapy for pts with mPDAC whose disease had not progressed for 4 months (m) in Cohort B or 6 m in C. Herein, we report on Cohorts B & C. Eligibility: ECOG 0-1, mPDAC meeting eligibility of B or C. POLAR (Pembrolizumab 200mg IV Q3W+ OLApaRib 300mg BID) until disease progression or limiting toxicity. Objective response rate (ORR), median PFS (mPFS), median overall survival (mOS), disease control rate (DCR), CA 19-9, cfDNA and baseline HRD mutational signature were analyzed. Results: Cohorts B and C enrolled N=15 each. N=25 pts evaluable by RECIST 1.1. Median follow-up 9.9 (1.3-22.8) and 11.3 (5.8-23) m, respectively. Efficacy details are shown. G3-5 AEs related to treatment: 5/14 (36%): 1 diarrhea (7%), 1 hyperglycemia (7%), 2 anemia (14%), 1 lipase increased (7%). Cohort B: 9/15 (60%) ATM, 3 CHEK2, 2 MUTYH, 1 BLM, 1 FANCC. Canonical gene mutations for mPDAC were less common for pts in Cohort B, especially in ATM PA group (n=9) vs C. Median genomic instability score (GIS) was computed and higher 28 (0-38) vs 9 (0-24) in Cohort B vs C, p=0.052. Median tumor mutation burden (TMB) was not different between B and C (3.3 and 4.1). Conclusions: Clinical activity of POLAR maintenance observed in select pts in B and C. Although PFS was modest (mPFS of 4m [2.1-5.4] in B + C), an intriguing survival signal (mOS at 14m [10-NR] from first POLAR dose) was seen in select patients without chemotherapy. Extensive correlative analyses underway to evaluate response and resistance (SPORE: 1P50CA257881-01A1). Cohort A (core HRD) actively accruing. Clinical trial information: NCT04666740.
Cohorts (N) | Cohort B (15) | Cohort C (15) | B and C (30) | ATMm (9) |
---|---|---|---|---|
Age at Dx (range). M:F | 62 (42-76). 7:8 | 65 (43-73). 8:7 | 64 (42-76). 15:15 | 62 (42-76). 5:4 |
De novo stage IV %(N) | 87 (13) | 100 (15) | 93 (28) | 89 (8) |
ORR % (# of pts evaluable for RECIST) | 0% (11) | 13.5% (14) | 8% (25) | 0% (8) |
DCR % | 60.0% | 46.5% | 62% (41-80) | 75% (35-97) |
Median PFS (95%CI) | 4m (4-NR) | 3.3m (1.9-5.4) | 4m (2.1-5.4) | 4m (2-NR) |
Median OS (95%CI) | NA (12-NR) | 11m (9.1-NR) | 14m (10-NR) | NA (12-NR) |
KRAS:TP53:SMAD4: CDKN2A (%) | 77:54:31:15 | 87:87:20:53 | 82:71:25:36 | 75:75:36:0 |
Median GIS (range) | 28 (0-38) | 9 (0-24) | 17 (0-38) | 24(1-30) |
Median TMB (range) | 3.3 (0.8-14.8) | 4.1 (1.6-8.2) | 3.7 (0.8-14.8) | 2.9 (0.8-4.40) |
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