Clinical efficacy of avapritinib in gastrointestinal stromal tumors (GIST) with different KIT genotypes: Post hoc analysis of the phase 1 NAVIGATOR and phase 1/2 CS3007-101 trials.

Authors

null

Michael C. Heinrich

Portland VA Health Care System and OHSU Knight Cancer Institute, Portland, OR

Michael C. Heinrich , Jian Li , Xinhua Zhang , Robin L Jones , Suzanne George , Jonathan C. Trent , Cesar Serrano , Yanhong Deng , Sebastian Bauer , Shirong Cai , Xin Wu , Yongjian Zhou , Kaixiong Tao , Zhichao Zheng , Jun Zhang , Yuehong Cui , Hui Cao , Meining Wang , Jin Hu , Lin Shen

Organizations

Portland VA Health Care System and OHSU Knight Cancer Institute, Portland, OR, Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, Royal Marsden Hospital, London, Chelsea, United Kingdom, Dana-Farber Cancer Institute, Boston, MA, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, Vall d'Hebron Institute of Oncology - Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, Sarcoma Center - West German Cancer Center, DKTK-Partner-Site, University of Duisburg Dept. of Medical Oncology, West German Cancer Center, Essen, Germany, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, Chinese People’s Liberation Army General Hospital, Beijing, China, Fujian Medical University Union Hospital, Fuzhou, China, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, Liaoning Cancer Hospital & Institute, Shenyang, Liaoning, China, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China, Fudan University Zhongshan Hospital, Shanghai, Xuhui District, China, Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, CStone (Suzhou) Pharmaceuticals, Jiangsu, Suzhou, China, CStone (Suzhou) Pharmaceuticals, Jiangsu, Suzhou,, China, Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, Haidian District, China

Research Funding

Other
CStone Pharmaceuticals

Background: Avapritinib, a novel KIT/platelet-derived growth factor receptor α (PDGFRA) kinase inhibitor, is approved in patients (pts) with GIST harboring PDGFRA activation loop (AL) exon 18 mutations, based on unprecedented clinical antitumor activity. Despite available treatments, there remains a great unmet medical need for pts with KIT-AL-mutant GIST receiving 2nd-line (2L) standard of care (SOC) sunitinib, and pts with primary KIT exon 9 (KIT 9)-mutant GIST receiving 4th-line (4L) SOC ripretinib. This post hoc analysis assessed the clinical benefit of avapritinib in pts with KIT mutations, especially with AL exons 17 and 18, or primary KIT 9 mutations. Methods: Tumor tissue and liquid biopsy samples were collected and analyzed to determine baseline mutational status. KIT molecular subgroups and outcomes were determined in pts with primary KIT mutations treated with oral avapritinib 300 mg once daily (starting dose) enrolled in the phase 1 NAVIGATOR (NCT02508532) and phase 1/2 (China bridging) trials (NCT04254939, CS3007-101). Pts with PDGFRA mutations and PDGFRA-KIT co-mutations were excluded. Progression-free survival (PFS) and objective response rate (ORR) were compared using Cox and logistic regression, respectively. Results: A total of 160 pts with KIT-mutant GIST were evaluated (NAVIGATOR, n= 131; CS3007-101, n= 29). At data cutoff (NAVIGATOR: March 31, 2021; CS3007-101: June 30, 2021), median follow-up duration was 22.0 months (95% CI 18.3–27.4). KIT-AL mutations were more frequently detected (n = 74, 46.3%) than KIT ATP-binding pocket (ABP) mutations (n = 34, 21.3%). Sixty pts (37.5%) had KIT-AL mutations without KIT-ABP mutations (ALposABPneg group); the remaining 100 pts were designated as KIT OTHERS. Across all lines of therapy, the adjusted (inverse probability weighting of baseline characteristics) median PFS (mPFS) was longer for the ALposABPneg group than for the KIT OTHERS group (9.1 vs 3.4 months; HR 0.47, 95% CI 0.32–0.68; P< 0.0001), and the ORR was higher (31.4% vs 12.1%; odds ratio 3.31, 95% CI 1.44–7.58; P= 0.0047). mPFS and ORR in the KIT ALposABPneg group were 19.3 months and 38.5%, respectively, in the 2L setting (n = 13) and 11.0 months and 36.4%, respectively, in Chinese pts (3–9 lines, n = 11). In pts with KIT 9 mutations in the 4L (n = 14) and > 4L settings (n = 19), mPFS was 5.6 and 3.7 months, respectively. Conclusions: This post hoc analysis demonstrated significantly more robust avapritinib antitumor activity in pts with KIT ALposABPneg GIST versus pts with other KIT mutation profiles. The results suggest that avapritinib could confer meaningful clinical benefit in pts with GIST and specific KIT mutation types, especially KIT-AL or KIT 9 mutations. Avapritinib might be a potential 2L option for pts with KIT ALposABPneg GIST, and in later lines of therapy for pts with ALposABPneg or KIT 9 mutation profiles. Clinical trial information: NCT02508532, NCT04254939.

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Poster Discussion Session

Session Title

Sarcoma

Track

Sarcoma

Sub Track

Gastrointestinal Stromal Tumors (GIST)

Clinical Trial Registration Number

NCT02508532, NCT04254939

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr 11523)

DOI

10.1200/JCO.2023.41.16_suppl.11523

Abstract #

11523

Poster Bd #

457

Abstract Disclosures