Phase 2 trial of pembrolizumab and olaparib (POLAR) maintenance for patients (pts) with metastatic pancreatic cancer (mPDAC): Two cohorts B non-core homologous recombination deficiency (HRD) and C exceptional response to platinum-therapy.

Authors

Wungki Park

Wungki Park

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

Organizations

Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, Memorial Sloan Kettering Cancer Center, New York, NY, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering, New York, NY, MSKCC, New York, NY

Research Funding

Pharmaceutical/Biotech Company
Merck Sharp & Dohme LLC, Parker Institute for Cancer Immunotherapy, U.S. National Institutes of Health

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:F62 (42-76). 7:865 (43-73). 8:764 (42-76). 15:1562 (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 (%)
77:54:31:1587:87:20:5382:71:25:3675:75:36:0
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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Abstract Details

Meeting

2023 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 - Advanced/Metastatic Disease

Clinical Trial Registration Number

NCT04666740

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr 4140)

DOI

10.1200/JCO.2023.41.16_suppl.4140

Abstract #

4140

Poster Bd #

461

Abstract Disclosures