Association of ctDNA tumor fraction with survival in advanced non-small cell lung cancer (NSCLC) treated with maintenance durvalumab in the UNICANCER SAFIR02-Lung/IFCT1301 trial.

Authors

null

Filippo Gustavo Dall'Olio

Cancer Medicine Department, Institut Gustave Roussy, Villejuif, France

Filippo Gustavo Dall'Olio , Damien Vasseur , Maryam Karimi , Stefan Michiels , Ludovic Lacroix , Pascale Tomasini , Judith Raimbourg , Noemie pata-Merci , Catherine Daniel , Henri Janicot , Anne Madroszyk , Clarisse Audigier-Valette , Ivan Bieche , Julien Mazieres , Denis Lucien MORO SIBILOT , Marta Jimenez , Jean-Charles Soria , Virginie Westeel , Fabrice Barlesi , Benjamin Besse

Organizations

Cancer Medicine Department, Institut Gustave Roussy, Villejuif, France, Gustave Roussy, Villejuif, France, Department of Biostatistics, Gustave Roussy; Oncostat U1018, Inserm, University Paris-Saclay, labeled Ligue Contre le Cancer, Villejuif, France, Office of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France, Assistance Publique Hôpitaux de Marseille (AP-HM), Marseille, ON, France, ICO institut de cancerologie de l'ouest, Nantes, France, Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France, Villejuif, France, Institut Curie, Paris, France, Department of Medical Oncology, Centre Hospitalier Universitaire de Clermont-Ferrand - Hôpital Gabriel Montpied, Clermont Ferrand, France, Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France, CHITS Toulon Sainte Musse, Pôle de Médecine à Orientation Oncologique, Toulon, France, Department of Genetics, Institut Curie and University of Paris, Paris, France, CHU de Toulouse, Pneumology Department, Paul Sabatier University, Toulouse, France, Centre Hospitalier Universitaire de Grenoble (France), Grenoble, France, Unicancer, Paris, France, Gustave Roussy Cancer Campus, Villejuif, France, CHU Besançon, Hôpital J. MINJOZ, Service de Pneumologie, Besançon, France, Gustave Roussy and Paris Saclay University, Faculty of Medicine, Villejuif / Kremlin-Bicêtre, France, Gustave Roussy, Villejuif and Paris-Sud University, Villejuif, France

Research Funding

Institutional Funding
Unicancer

Background: ctDNA shed is a promising biomarker for cancer immunotherapy, with patients (pts) having higher concentration of plasma ctDNA being reported to have poorer outcome. Its role in the maintenance setting with immune checkpoint inhibitors remains unexplored. In SAFIR02-Lung, advanced NSCLC pts were enrolled to receive a platinum-based chemotherapy. After 4 cycles, if stable or in response, pts with no targetable alterations were oriented to the immunotherapy sub-study and randomized between maintenance durvalumab or Standard of Care (SoC) (PMID 35802649). Durvalumab prolonged survival only in the PD-L1 ≥ 1% subgroup. Here we explored Tumor Fraction (TF) as determined by Low-Pass Whole Genome Sequencing as a biomarker for immunotherapy irrespective of PD-L1. Methods: SAFIR02-Lung (NCT02117167) is a multicentric, randomized phase 2 clinical trial. Plasma samples were obtained at randomization, just before maintenance treatment initiation. DNA was extracted using the Maxwell RSC ccfDNA Plasma Kit (Promega, AS1840). Sequencing libraries were prepared using the Low Input SureSelectXT protocol (Agilent, G9916A). Pooled libraries were sequenced on a NovaSeq 6000 platform (Illumina) as 2 × 150 bp paired-end reads (NovaSeq 6000 SP Reagent Kit v1.5). Genomic copy number aberrations and TF were investigated using the ichorCNA (V0.2.0) tool. TF ≥ 2% was considered positive. For the survival analyses, a landmark approach was performed, by considering the randomization date as the landmark time. Progression Free Survival (PFS) was the primary endpoint, defined as the time from randomization until the date of objective radiological disease progression, clinical progression or death. The secondary endpoint was Overall Survival (OS). Results: 50 out of 121 plasma samples from pts randomized to durvalumab were analyzed for the feasibility part. 34 pts (68%) were < 65 years, 33 (66%) were male. PD-L1 expression was available for 18 pts and 39% of them had PD-L1 ≥ 1%. Median TF was 1.1%, 8 pts (16%) had a TF ≥ 2%, ranging from 2.2% to 23.3%. TF at randomization was marginally correlated with the presence of liver metastases (p 0.063) and with the sum of target lesions (p 0.081). No significant correlation was observed with PD-L1 positivity. Pts with TF ≥ 2% had lower median PFS 1.7months (m) (95% CI 1.2 – 4.2) vs 5.8m (95% CI 2.9 – 7.5) for those with TF < 2%, p 0.0003. Similarly, median OS was lower for pts with TF > 2% 10.4m (95% CI 4.2 – 18.7) vs 25.9m (95% CI 18.2 – NR) for those with TF < 2%, p 0.0002. Data will be presented on the whole cohort, including control group receiving SoC, to discriminate between a prognostic or a predictive value of TF. Conclusions: TF was positive in 16% of pts randomized to durvalumab in the SAFIR02-Lung trial. This population seems to have a limited benefit from maintenance durvalumab after induction chemotherapy. Clinical trial information: NCT02117167.

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Rapid Oral Abstract Session

Session Title

Developmental Therapeutics - Immunotherapy

Track

Developmental Therapeutics—Immunotherapy

Sub Track

Circulating Biomarkers

Clinical Trial Registration Number

NCT02117167

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr 2516)

DOI

10.1200/JCO.2023.41.16_suppl.2516

Abstract #

2516

Abstract Disclosures