Efficacy and safety of Kras inhibitors in pancreatic cancer: A systematic review of clinical trials.

Authors

null

Sindhusha Veeraballi

New York Medical College - Saint Michael's Medical Center, Newark, NJ

Sindhusha Veeraballi , Wajeeha Aiman , Amaar Ahmad , Navjot Grewal , Murad Qirem , Samer Jumean , Sahar Memar Montazerin , Muhammad Ashar Ali , Gunwant K. Guron , Hamid Salim Shaaban

Organizations

New York Medical College - Saint Michael's Medical Center, Newark, NJ, Saint michaels medical center, Newark, Saint Mary's and Saint Clare's Hospital, New York Medical College, Denville, NJ, St. Michael's Medical Ctr, Newark, NJ, Reg Cancer Ctr At St Michael's Medical Ctr, Newark, NJ

Research Funding

No funding received
None.

Background: Pancreatic ductal adenocarcinoma (PDAC) is the most aggressive tumor and is one of the leading causes of cancer related deaths worldwide. Kirsten Rat Sarcoma (KRAS)mutation resulting in tumor cell proliferation and cancer progression is a frequently mutated oncogene in various cancers and is approximately seen in 90% of pancreatic ductal adenocarcinoma. Efforts are being done to target Kras mutation in the last 3–4 decades. Here in, we report the results of the systemic review of clinical trials done on chemotherapeutic agents targeting Kras mutated pancreatic cancer. Methods: We followed PRISMA guidelines to conduct this systematic review. A literature search was performed on PubMed, Clinicaltrials.gov, and Embase with mesh terms, “pancreatic neoplasm’’ and “kras” from the inception of data till 01/05/2023. We screened 4191 articles and included 3 clinical trials with published study results and 3 ongoing clinical trials. Results: In this systematic review, data on 2 chemotherapeutic agents Sotorasib (AMG510) and Adagrasib (MRTX849) which are Kras G12C inhibitors, are obtained from Code Break-100 and preliminary results of KRYSTAL-1 clinical trials, respectively. In these 2 clinical trials (N-48), all the patients had advanced pancreatic cancer with Kras G12C mutation and were previously treated with chemotherapy. 10 patients in Krystal-1 trial, who received adagrasib showed progression-free survival (PFS) of 6.6 months, disease control rate (DCR) of 100 % and partial response (PR) of 50%. 38 patients in the Code Break-100 trial, who received Sotorasib showed PFS of 4 months, DCR of 84.2% and PR of 21.1%. However, 50% of patients in the KRYSTAL-1 trial are still receiving treatment. Grade 3 /4 adverse events were seen in 21% and 16% of patients in the KRYSTAL-1 and Code Break-100 trial, respectively. Other Kras G12C inhibitors like D-1553, Sotorasib in combination with 2nd line chemotherapy are under investigation. Results of a clinical trial on anti KrasG12D siRNA done on locally advanced pancreatic cancer patients showed a median overall survival of 15.12 months with no dose limiting adverse events. A multinational randomized phase 2b clinical trial is ongoing for the evaluation of efficacy of siRNA based drug in combination with chemotherapy. Conclusions: Both Adagrasib and Sotorasib showed promising results in the pretreated Kras G12C pancreatic cancer patients with acceptable safety profile. Further exploration of these drugs and their combination with other chemotherapeutic agents is necessary.

AuthorDrug regimenNORRComplete response (CR)(PR)DCROverall survival (OS)PFS
Bekaii-Saab et al. 2022Adagrasib (MRTX849)10 50% so farNA50%100%50% pts Ongoing treatment6.6 months
Strickler, J. H et al. 2023Sotorasib38 21%0%21.1%84.2%6.9 months4 months
Golan, T et al.2015
Anti KrasG12D siRNA + chemotherapy12 NANA25% at 6 months follow up13.3%15.12 monthsNA
60% at 8.5 months follow up

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Track

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Sub Track

Pancreatic Cancer - Advanced/Metastatic Disease

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr e16297)

DOI

10.1200/JCO.2023.41.16_suppl.e16297

Abstract #

e16297

Abstract Disclosures