Abstract CT148: Small molecule immune-modulator icaritin: Safety, durable survival and inflammation-immune biomarkers in advanced hepatocellular carcinoma

Abstract

Abstract Objectives: Hepatocellular carcinoma (HCC) was characterized with high heterogeneity and immune “tolerogenic”. Despite of immune checkpoint inhibitors have demonstrated promising results with improved overall survival. Novel small molecule-based immune therapies with high safety profiles might be particularly needed for advanced HCC patients. The purpose of this Phase II study is to explore the safety, clinical activities and treatment associated inflammation-immune biomarkers of icaritin in advanced HCC. Methods: Major eligibility criteria include histologically confirmed unresectable, HCC patients with Child-Pugh Class A or B liver function. Total of 70 advanced HCC patients were enrolled and administrated with 600 mg b.i.d. Primary endpoints were TTP, and secondary endpoints were safety, OS, and DCR. Local disease control was defined as no progressive disease (PD) by RECIST. Kaplan-Meier analysis was utilized for OS assessment. Inflammation-Immune biomarkers NLR, PLR, cytokines, baseline expression of checkpoint/immune gene panel including PD-L1/L2, TIM3, IDO, HLA were evaluated by Nanostring and NGS technologies, retrospectively. Results: There was no ≥ grade III drug related AE observed in all enrolled 70 advanced HCC patients. Objective response evaluation in per-protocol population showed PR (1.6%), SD (32.8%) and PD (59.0%) and median overall survival (OS) 254day (95% CI, 172-296). DCR was achieved 34.4% (95% CI, 22.7-47.7%); Median OS for the PD-L1-positive (n=9) and negative (n=24) subgroups were 389 (95% CI, 80-522) vs. 286.5days (95%CI, 135-482), for IL-6-advantage (n=28) and disadvantage (n=16) subgroups were 328.5 (95% CI, 277-566) vs. 168 days (95% CI, 135-482), for IL-8 low (n=22) and high (n=22) subgroups were 475.5(95% CI, 309-NA) vs. 175days (95% CI, 135-295), respectively. Overall survival was significantly associated with patient genetic profiles such as neo-antigen, bacterial and viral DNA inserts. Conclusion: Icaritin has demonstrated its favorable clinical safety and preliminary immune-modulation efficacy. Potential baseline immune biomarkers to predict the improved OS were suggested including immune cell PD-L1 expression, low level peripheral IL-8, PLR, neoantigen and infection-associated genetic variations. Both safety and immune-response efficacy are warranted for the further Phase III validation. Citation Format: Shu-Kui Qin, Qing Li, Jianmin Xu, Jun Liang, Ying Cheng, Shu Li, Limin Zheng, Bin Ye, Kun Meng, Yan Sun. Small molecule immune-modulator icaritin: Safety, durable survival and inflammation-immune biomarkers in advanced hepatocellular carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr CT148.