Phase II study of ceralasertib (AZD6738), in combination with durvalumab in patients with metastatic melanoma who have failed prior anti-PD-1 therapy.

Abstract

9514 Background: Alterations in DNA damage response (DDR) and repair are associated with genomic instability and increased somatic tumor mutational burden, and modulating DNA repair is a promising strategy to boost the efficacy of cancer immunotherapy. Ceralasertib is an oral inhibitor of the serine/threonine protein kinase Ataxia Telangiectasia and Rad3 Related (ATR), which is crucial to the cell’s response to replication stress. Methods: This phase 2 trial was designed to evaluate the efficacy and safety of ceralasertib in combination with durvalumab in patients with metastatic melanoma (MM) who had failed to anti-PD-1 therapy. The study drug schedule was: ceralasertib at 240 mg BD on days 15 to 28 in combination with durvalumab at 1500 mg on day 1 in a 28-day cycle. The primary end point was overall response rate (ORR) by RECIST (v1.1). To investigate markers predictive of clinical outcome, fresh tumor biopsies were obtained from all enrolled patients before treatment. Results: From August 2019 to May 2020, 30 MM patients (median # of lines, 2; range, 2 - 5) were enrolled. All enrolled patients were exposed to prior anti-PD-1 treatment (immediate failure, n = 23). The ORR was 30.0% (9 PRs, 10 SDs, 10 PDs), DCR 63.3%, median PFS 7.1 months (95% confidence interval (CI), 3.6-10.6), and median OS was 14.2 months (95% CI, 9.3-19.1). Common adverse events of any grade were anemia (n = 23, 76.7%), anorexia (n = 20, 66.7%) and thrombocytopenia (n = 19, 63.3%). Common adverse events of grade 3 or more included anemia (n = 10, 33.3%). One death occurred due to febrile neutropenia in a patient with a pre-existing wound infection. Conclusions: Ceralasertib in combination with durvalumab demonstrated a promising anti-tumor activity, particularly in melanoma patients who failed to standard of care including anti-PD1 treatment. Clinical trial information: NCT03780608.