RECIST V1 Research Articles

Real-world efficacy and safety of TACE-HAIC combined with TKIs and PD-1 inhibitors in initially unresectable hepatocellular carcinoma

BackgroundLocal treatment may function synergistically with immunotherapy and targeted agents. This study aimed to assess the effectiveness and safety of transcatheter arterial chemoembolization (TACE) and hepatic artery infusion chemotherapy (HAIC) combined with tyrosine kinase inhibitors (TKIs) and programmed death-1 (PD-1) inhibitors in patients with initially unresectable hepatocellular carcinoma (uHCC). MethodsA retrospective study was conducted on patients diagnosed with initially uHCC who received combined treatment of TACE-HAIC combined with TKIs and PD-1 inhibitors from July 2020 to February 2023. The primary endpoints were overall survival (OS) and progression free survival (PFS) and adverse events (AEs). Objective response rate (ORR), disease control rate (DCR) and conversion surgery rate (CSR), whereas the secondary endpoints. ResultsAfter screening, a total of 62 patients were selected for this study. The overall median OS was 18.2 (95% CI 16.24–20.16) months and median PFS was 9.2 (95% CI 7.24–11.16) months. Based on the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria and RECIST v1.1 criteria, ORR was 67.7% (42/62), and the DCR was 90.3% (56/62), the CSR was 27.4% (17/62). The most common treatment-emergent adverse events (TEAEs) were transaminitis (56.4%, 35/62), nausea and vomiting (43.5%, 27/62), thrombocytopenia (37.1%, 23/62), abdominal pain (33.9%, 21/62), and fever (33.9%, 21/62). ConclusionsTKIs combined with PD-1 inhibitors plus TACE-HAIC therapy represents an effective and tolerable treatment option in patients with uHCC. Patients undergoing surgery after combination therapy may have survival benefits.

TRLS-08. ROVER: A PHASE 1/2 TRIAL IN PROGRESS OF AVAPRITINIB IN PEDIATRIC PATIENTS WITH SOLID TUMORS DEPENDENT ON KIT OR PDGFRA SIGNALING

Abstract BACKGROUND Advanced pediatric solid tumors, including central nervous system (CNS) tumors with PDGFRA and/or KIT mutations/amplifications are aggressive diseases with limited treatment options. KIT alterations occur in germ cell tumors and high-grade glioma (HGG); platelet-derived growth factor receptor alpha (PDGFRA) alterations are common in sarcoma and HGG. No KIT-/PDGFRA-targeted therapies are currently approved for pediatric patients. The selective KIT and PDGFRA inhibitor avapritinib has demonstrated potent activity against KIT activation-loop (exon 17) and juxtamembrane (exon 11) mutants (IC50<2 nM), and PDGFRA activation-loop (D842V) mutants (half-maximal inhibitory concentration [IC50]=0.24 nM). Cellular IC50 of wild-type PDGFRA was 95 nM. CNS penetration in preclinical models (steady-state brain-to-plasma ratios, 0.74–1.00) indicates potential for CNS antitumor activity. Avapritinib is approved in the USA and Europe to treat adults with indolent systemic mastocytosis, in the USA for adults with advanced systemic mastocytosis (AdvSM), and in Europe for adults with AdvSM after ≥1 prior systemic therapy. Avapritinib is also approved to treat adults with unresectable/metastatic gastrointestinal stromal tumors harboring PDGFRA exon 18 mutations (including D842V) in the USA and PDGFRA D842V mutations in Europe. METHODS ROVER, a 2-part phase 1/2, multicenter, open-label study (NCT04773782), is investigating avapritinib (once daily, administered in continuous 28-day cycles) in pediatric patients aged 2 to <18 years with relapsed/refractory solid tumors that harbor PDGFRA and/or KIT mutations/amplifications or patients with diffuse midline glioma H3K27-altered (DMG-H3K27a). Objectives include safety, efficacy, and pharmacokinetics. Part 1 will enroll ≥12 patients; primary endpoint is to determine the recommended Part 2 dose (RP2D). Part 2 will enroll ≥25 patients at the RP2D; primary endpoint is objective response rate per RECIST v1.1 for solid tumors and Response Assessment in Neuro-Oncology for CNS tumors. Study enrollment is planned at 26 sites in 9 countries, including North America, Europe, and Asia/Pacific.

Assessment of serum tumor markers CEA, CA-125, and CA19-9 as adjuncts in non-small cell lung cancer management.

Conventional tumor markers may serve as adjuncts in non-small cell lung cancer (NSCLC) management. This study analyzed whether three tumor markers (CEA, CA19-9, and CA-125) held associations with radiographic and clinical outcomes in NSCLC. It constituted a single-center study of NSCLC patients treated with systemic therapy at the London Regional Cancer Program. Serum tumor markers were analyzed for differences in radiographic responses (RECIST v1.1 or iRECIST), associations with clinical characteristics, and all-cause mortality. A total of 533 NSCLC patients were screened, of which 165 met inclusion criteria. A subset of 92 patients had paired tumor markers and radiographic scans. From the latter population, median (IQR) fold-change from nadir to progression was 2.13 (IQR 1.24-3.02; p < 0.001) for CEA, 1.46 (IQR 1.13-2.18; p < 0.001) for CA19-9, and 1.53 (IQR 0.96-2.12; p < 0.001) for CA-125. Median (IQR) fold-change from baseline to radiographic response was 0.50 (IQR 0.27, 0.95; p < 0.001) for CEA, 1.08 (IQR 0.74, 1.61; p = 0.99) for CA19-9, and 0.47 (IQR 0.18, 1.26; p = 0.008) for CA-125. In conclusion, tumor markers are positioned to be used as adjunct tools in clinical decision making, especially for their associations with radiographic response (CEA/CA-125) or progression (CEA/CA-125/CA-19-9).

Clinical outcomes of image-guided therapies in patients with adrenocortical carcinoma: a tertiary referral center retrospective study.

Image-guided therapies (IGTs) are commonly used in oncology, but their role in adrenocortical carcinoma (ACC) is not well defined. A retrospective review of patients with ACC treated with IGTs. We assessed response to therapy using RECIST v1.1, time to next line of systemic therapy, disease control rate (DCR), local tumor progression-free survival (LTPFS), and complications of IGTs (based on the Common Terminology Criteria for Adverse Events [CTCAE] version 5.0). Our cohort included 26 patients (median age 56 years [range 38-76]; n = 18 female) who had 51 IGT sessions to treat 86 lesions. IGTs modalities included cryoablation (n = 49), microwave ablation (n = 21), combined microwave and bland trans-arterial embolization (n = 8), bland trans-arterial embolization alone (n = 3), radio-embolization (n = 3), and radiofrequency ablation (n = 2). DCR was 81.4% (70 out of 86), of which 66.3% of tumors showed complete response, 18.6% showed progressive disease, 8.1% showed partial response, and 7.0% showed stable disease. LTPFS rates were 73% and 63% at 1 and 2 years, respectively. Fourteen lesions underwent re-ablation for incomplete response on initial treatment. Sixteen patients (61.5%) received new systemic therapy following IGTs, with a median time to systemic therapy of 12.5 months (95% CI: 8.6 months upper limit not reached). There was 1 reported CTCAE grade 3 adverse event (biloma) following IGT. IGT use in properly selected patients with ACC is safe and associated with prolonged disease control and delay in the need for systemic therapy.

Atezolizumab in patients (pts) with tumor mutational burden (TMB)–high tumors from the TAPISTRY trial.

LBA2509 Background: Studies have suggested that pts with TMB-high tumors could derive clinical benefit from atezolizumab, a PD-L1 inhibitor; however, these studies used inconsistent TMB cutoffs. We report efficacy and safety data of atezolizumab in adult and pediatric pts with TMB-high advanced/metastatic solid tumors from Cohort D of the TAPISTRY trial (NCT04589845), using two TMB cutoffs: ≥13 mutations [mut]/Mb and ≥16 mut/Mb. Methods: TAPISTRY is a phase II, global, open-label, multicohort basket trial evaluating the efficacy and safety of multiple therapies in pretreated pts with advanced/metastatic solid tumors. Pts in Cohort D had advanced unresectable/metastatic, PD-L1 inhibitor-naïve, TMB-high (≥13 mut/Mb) solid tumors. Atezolizumab was given every 21 days, at 1200 mg in pts ≥18 years old, and at ≥15 mg/kg (up to 1200 mg) in pts &lt;18 years old. Tumor responses were assessed per RECIST v1.1. Primary endpoint: objective response rate (ORR) by independent review committee (IRC) in pts with TMB ≥16 mut/Mb. Secondary endpoints included ORR by IRC in pts with TMB ≥13 mut/Mb, duration of response (DoR), progression-free survival (PFS), overall survival (OS) and safety. Results: At data cut-off (Nov 9, 2023), 150 pts with TMB ≥13 mut/Mb were enrolled. In the safety-evaluable population (n = 148), median age was 63 years (range 11–86); 56% of pts were male, and 56% had received ≥2 prior lines of therapy (median 2; range 0–14). The efficacy-evaluable population included 129 pts with TMB ≥13 mut/Mb (TMB ≥16 mut/Mb; n = 111); the most common tumor types were colorectal (n = 40; 31%), breast, and gastroesophageal cancer (n = 11 each; 9%). Key outcomes are presented (Table). After a median follow-up of 9.8 months, ORR by IRC was comparable between pts with TMB ≥16 mut/Mb (22.5%) and pts with TMB ≥13 mut/Mb (20.2%). Responses were seen across a variety of tumor types. DoR 6- and 12-month event-free rates were 79% and 72%, respectively. Median PFS was short, suggesting fast disease progression in non-responders. Fatigue (22%) and anemia (20%) were the most common adverse events. Safety of atezolizumab was consistent with its known profile. Conclusions: Atezolizumab was well tolerated and led to antitumor activity in pts with TMB-high solid tumors. Responses were seen across a variety of tumor types. Clinical trial information: NCT04589845 . [Table: see text]

Subcutaneous amivantamab and lazertinib as first-line treatment in patients with EGFR-mutated, advanced non-small cell lung cancer (NSCLC): Results from the phase 2 PALOMA-2 study.

LBA8612 Background: Amivantamab (ami), an EGFR-MET bispecific antibody with immune cell-directing activity, is approved as an intravenous (IV) formulation. IV ami + lazertinib (laz), a 3rd-generation EGFR TKI, demonstrated superior progression-free survival (PFS) in patients (pts) with treatment-naïve, advanced EGFR-mutated NSCLC vs osimertinib (Cho Ann Oncol 2023). Subcutaneous (SC) ami substantially reduced infusion-related reactions (16% vs 67%) and administration time (≤7 mins vs 2–4 hours) vs historical IV experience (Minchom JCO 2023). PALOMA-2 (NCT05498428) evaluated the efficacy, safety, and pharmacokinetics (PK) of first-line SC ami+laz. Methods: Cohorts 1 and 6 enrolled pts with treatment-naïve, EGFR Ex19del or L858R-mutated advanced NSCLC. Prophylactic anticoagulation for the first 4 months (mo) of treatment was recommended in cohort 1 and mandatory in cohort 6. SC ami was administered by manual injection in the abdomen at 1600 mg (≥80 kg: 2240 mg) weekly for the first 4 weeks and every 2 weeks thereafter. Laz was dosed orally at 240 mg daily. The primary endpoint was objective response rate (ORR) as assessed by the investigator per RECIST v1.1. Results: As of 6 Jan 2024, 68 and 58 pts were enrolled in cohorts 1 and 6, respectively. Overall, median age was 59 years, 60% were female, and 68% Asian. The median follow-up was 10 mo for cohort 1 and 6 mo for cohort 6. ORR (confirmed responses) in cohort 1 was 68% (95% CI, 55–79) by investigator and 72% (95% CI, 60–82) by independent central review. ORR in cohort 6 was 64% (95% CI, 49–78) and 73% (95% CI, 58–85), respectively. At data cutoff, 40/46 responders in cohort 1 and 29/29 responders in cohort 6 were receiving ongoing treatment. Best overall response rates (includes unconfirmed responses) were 81% (95% CI, 70–89) for cohort 1 and 76% (95% CI, 61–87) for cohort 6. Median time to response was 2 mo (range, 1.4–5.3). Median duration of response, PFS, and overall survival were not estimable. Administration-related reactions (ARRs) were reported in 13 (19%) pts in cohort 1 and 6 (11%) pts in cohort 6, all grade 1–2. EGFR- and MET-related AEs were primarily grade 1–2. Total of 71% of pts in cohort 1 and 100% in cohort 6 received prophylactic anticoagulation. Venous thromboembolic events (VTE) were reported in 18% and 7% of pts in cohorts 1 and 6, respectively. There were no dose reductions or discontinuations due to VTE. Rate of bleeding was 2% among pts receiving anticoagulation. Mean ami concentrations on cycle 2 day 1 were 328 µg/mL (n=49) in cohort 1 and 371 µg/mL (n=41) in cohort 6, consistent with historic IV levels. Conclusions: SC ami+laz showed a response rate similar to historic IV ami+laz in first-line EGFR-mutated NSCLC, with an improved safety profile that included significantly lower ARR rates. Further, prophylactic anticoagulation can be safely implemented and reduced incidence of VTE. Clinical trial information: NCT05498428 .

Nivolumab (NIVO) plus ipilimumab (IPI) vs lenvatinib (LEN) or sorafenib (SOR) as first-line treatment for unresectable hepatocellular carcinoma (uHCC): First results from CheckMate 9DW.

LBA4008 Background: First-line therapies based on programmed death ligand 1 (PD-L1) inhibitors are standard of care (SOC) in uHCC and demonstrate improved outcomes over SOR; however, prognosis remains poor and there is an unmet need for alternative therapies with long-term benefits. Second-line NIVO + IPI demonstrated clinically meaningful efficacy and manageable safety in SOR-treated patients (pts) with HCC in CheckMate 040, leading to its accelerated approval in the United States. We report first results from the preplanned interim analysis of the phase 3, open-label, randomized CheckMate 9DW trial evaluating the efficacy and safety of NIVO + IPI vs LEN or SOR as first-line therapy for pts with uHCC (NCT04039607). Methods: Adult pts with previously untreated HCC not eligible for curative surgical or locoregional therapies, Child-Pugh score 5–6, and ECOG performance status 0–1 were included. Pts were randomly assigned 1:1 to receive NIVO 1 mg/kg + IPI 3 mg/kg Q3W (up to 4 cycles) followed by NIVO 480 mg Q4W or investigator’s choice of LEN 8 mg or 12 mg QD or SOR 400 mg BID until disease progression or unacceptable toxicity. NIVO was given for a maximum of 2 years. The primary endpoint was overall survival (OS). Secondary endpoints included objective response rate (ORR) and duration of response (DOR) per blinded independent central review (BICR) using RECIST v1.1. Results: In total, 668 pts were randomized to NIVO + IPI (n = 335) or LEN/SOR (n = 333); among 325 pts treated in the LEN/SOR arm, 275 (85%) received LEN. After a median (range) follow-up of 35.2 (26.8–48.9) months (mo), median OS was 23.7 mo with NIVO + IPI vs 20.6 mo with LEN/SOR (HR, 0.79; 95% CI, 0.65–0.96; P = 0.0180) (Table), with respective 24-mo OS rates (95% CI) of 49% (44–55) vs 39% (34–45). ORR was higher with NIVO + IPI (36%) vs LEN/SOR (13%; P &lt; 0.0001); complete response was observed in 7% of pts with NIVO + IPI vs 2% with LEN/SOR. Median DOR was 30.4 mo with NIVO + IPI vs 12.9 mo with LEN/SOR (Table). A summary of treatment-related adverse events (TRAEs) is shown in the Table. Conclusions: NIVO + IPI demonstrated statistically significant OS benefit vs LEN/SOR in pts with previously untreated uHCC, as well as higher ORR and durable responses with a manageable safety profile. These results support this combination as a potential new first-line SOC for uHCC. Clinical trial information: NCT04039607 . [Table: see text]

ADRIATIC: Durvalumab (D) as consolidation treatment (tx) for patients (pts) with limited-stage small-cell lung cancer (LS-SCLC).

LBA5 Background: The standard of care (SoC) for pts with LS-SCLC is concurrent platinum-based chemoradiotherapy (cCRT) ± prophylactic cranial irradiation (PCI). ADRIATIC (NCT03703297), a phase 3, randomized, double-blind, placebo (PBO)-controlled, multicenter, global study, assessed D ± tremelimumab (T) as consolidation tx for pts with LS-SCLC who had not progressed after cCRT. Here we report results for D vs PBO from the first planned interim analysis (IA). Methods: Eligible pts had stage I–III LS-SCLC (stage I/II inoperable) and WHO performance status 0/1, and had not progressed after cCRT. PCI was permitted before randomization. Pts were randomized 1–42 days after cCRT to D 1500 mg + PBO, D 1500 mg + T 75 mg, or PBO + PBO every 4 weeks (Q4W) for 4 cycles, followed by D (D±T arms) or PBO Q4W until investigator-determined progression or intolerable toxicity, or for a maximum of 24 months (mo). The first 600 pts were randomized in a 1:1:1 ratio; subsequent pts were randomly assigned 1:1 to D or PBO. Randomization was stratified by stage (I/II vs III) and receipt of PCI (yes vs no). The dual primary endpoints were OS and PFS (blinded independent central review per RECIST v1.1) for D vs PBO. OS and PFS for D+T vs PBO were alpha-controlled secondary endpoints. Results: 730 pts were randomized, including 264 to D and 266 to PBO. Baseline characteristics and prior tx were well balanced between arms. Radiation schedule in the D vs PBO arms was once daily in 73.9% vs 70.3% of pts and twice daily in 26.1% vs 29.7%; 53.8% of pts in each arm received PCI. At this IA (data cutoff 15Jan2024), median (range) duration of follow-up for OS and PFS in censored pts was 37.2 (0.1–60.9) and 27.6 (0.0–55.8) mo, respectively. OS was significantly improved with D vs PBO (HR 0.73 [95% CI 0.57–0.93]; p=0.0104; median OS 55.9 [95% CI 37.3 – not estimable] vs 33.4 [25.5–39.9] mo; 24-mo OS rate 68.0% vs 58.5%; 36-mo OS rate 56.5% vs 47.6%). PFS was also significantly improved with D vs PBO (HR 0.76 [95% CI 0.61–0.95]; p=0.0161; median PFS 16.6 [95% CI 10.2–28.2] vs 9.2 [7.4–12.9] mo; 18-mo PFS rate 48.8% vs 36.1%; 24-mo PFS rate 46.2% vs 34.2%). Tx benefit was generally consistent across predefined pt subgroups for both OS and PFS. With D vs PBO, maximum grade 3/4 all-cause adverse events (AEs) occurred in 24.3% vs 24.2% of pts; AEs led to tx discontinuation in 16.3% vs 10.6% of pts and to death in 2.7% vs 1.9%. Any-grade pneumonitis/radiation pneumonitis was reported in 38.0% vs 30.2% of pts with D vs PBO (maximum grade 3/4 in 3.0% vs 2.6%). The D+T arm remains blinded until the next planned analysis. Conclusions: D as consolidation tx after cCRT demonstrated a statistically significant and clinically meaningful improvement in OS and PFS compared with PBO in pts with LS-SCLC. D was well tolerated and AEs were consistent with the known safety profile, with no new signals observed. These data support consolidation D as a new SoC for pts with LS-SCLC who have not progressed after cCRT. Clinical trial information: NCT03703297 .

Osimertinib (osi) after definitive chemoradiotherapy (CRT) in patients (pts) with unresectable stage (stg) III epidermal growth factor receptor-mutated (EGFRm) NSCLC: Primary results of the phase 3 LAURA study.

LBA4 Background: EGFR mutations occur in up to one-third of pts with unresectable stg III NSCLC. Consolidation durvalumab is standard of care (SoC) for pts who do not progress after concurrent CRT (cCRT), yet the benefit of consolidation immunotherapy specifically for EGFRm NSCLC remains uncertain, with limited data available. Osi, a 3rd-generation CNS-active EGFR-TKI, is recommended for EGFRm advanced/metastatic NSCLC and as adjuvant therapy for resectable EGFRm NSCLC. We report primary results from the global, double-blind, placebo (PBO)-controlled Phase 3 LAURA study (NCT03521154), assessing efficacy/safety of osi in unresectable stg III EGFRm NSCLC without progression after definitive CRT. Methods: Eligible pts: aged ≥18 years (≥20 in Japan), WHO PS 0/1, unresectable stg III EGFRm (Ex19del/L858R) NSCLC, had received definitive platinum-based cCRT/sequential CRT (sCRT) with no progression. Pts were stratified (cCRT vs sCRT; stg IIIA vs IIIB/IIIC; Chinese vs non-Chinese) and randomized 2:1 to receive osi 80 mg or PBO QD until progression (blinded independent central review [BICR]-confirmed)/discontinuation. Imaging, including brain MRI, was mandated at baseline, every 8 wks to wk 48, then every 12 wks, until progression by BICR. Open-label osi was offered after progression by BICR. Primary endpoint: progression-free survival (PFS; RECIST v1.1) assessed by BICR. Secondary endpoints included overall survival (OS) and safety. Data cut-off: January 5, 2024. Results: Overall, 216 pts were randomly assigned: osi n=143, PBO n=73. Baseline characteristics were generally balanced across osi/PBO arms: female 63/58%, stg IIIA 36/33%, IIIB 47/52%, IIIC 17/15%, Ex19del 52/59%. Osi significantly improved PFS by BICR vs PBO: HR 0.16; 95% CI 0.10, 0.24; p&lt;0.001. Median PFS was 39.1 mo (95% CI 31.5, not calculable) for osi vs 5.6 mo (95% CI 3.7, 7.4) for PBO; 12-mo PFS rate was 74% (osi) vs 22% (PBO); 24-mo PFS rate was 65% (osi) vs 13% (PBO). Investigator-assessed PFS (HR 0.19; 95% CI 0.12, 0.29; nominal p&lt;0.001) was consistent with PFS by BICR. PFS benefit was consistent across predefined subgroups. Interim OS analysis (20% maturity) showed a trend in favor of osi: HR 0.81; 95% CI 0.42, 1.56; p=0.530; 81% of pts (PBO arm) received osi after progression. All-causality AEs were reported in 98% vs 88% pts; ≥Grade 3 AEs in 35% vs 12%; serious AEs in 38% vs 15% for osi vs PBO, respectively. Radiation pneumonitis AEs (grouped term): 48% (osi) vs 38% (PBO), majority Grade 1/2. Any AEs leading to discontinuation were reported in 13% vs 5% for osi vs PBO, respectively. Conclusions: Osi after definitive CRT demonstrated a statistically significant and clinically meaningful improvement in PFS, for unresectable stg III EGFRm NSCLC, with no unexpected safety signals. These results establish osi as the new SoC for EGFRm NSCLC in this setting. Clinical trial information: NCT03521154 .

KRYSTAL-12: Phase 3 study of adagrasib versus docetaxel in patients with previously treated advanced/metastatic non-small cell lung cancer (NSCLC) harboring a KRASG12C mutation.

LBA8509 Background: Adagrasib (ADA) is a potent covalent inhibitor of KRASG12C with favorable properties such as long half-life (23 h), dose-dependent pharmacokinetics, and brain penetrance. In the phase 1/2 KRYSTAL-1 trial, ADA demonstrated deep and durable responses with promising PFS and OS in patients (pts) with previously treated KRASG12C-mutated NSCLC. Here, we report the primary analysis from KRYSTAL-12 (NCT04685135), a randomized, open-label phase 3 trial of ADA compared with docetaxel (DOCE) in pts with KRASG12C-mutated locally advanced or metastatic NSCLC who had previously received a platinum-based chemotherapy, concurrently or sequentially with anti-PD-(L)1 therapy. Methods: Pts with KRASG12C-mutated locally advanced or metastatic NSCLC, previously treated with platinum-based chemotherapy and anti-PD-(L)1 therapy, were randomized 2:1 (stratified by region [non-Asia Pacific vs Asia Pacific] and sequential vs concurrent chemoimmunotherapy) to receive ADA (600 mg BID orally; tablet formulation) or DOCE (75 mg/m2 Q3W IV), with the ability to crossover to ADA upon disease progression (assessed by real-time blinded independent central review [BICR]). No washout period was required between prior anti-PD-(L)1 therapy and study treatment. Primary endpoint was PFS assessed per BICR according to RECIST v1.1. Secondary endpoints included ORR by BICR, duration of response (DOR), OS, 1-year OS rate, and safety. Results: In total, 301 pts were randomized to ADA and 152 to DOCE. Baseline characteristics were generally similar between treatment arms. With a median follow-up of 9.4 mo (data cutoff 31 Dec, 2023), the primary endpoint of PFS was significantly improved with ADA over DOCE (HR 0.58 [95% CI, 0.45–0.76]; P &lt; 0.0001; median PFS 5.49 vs 3.84 mo). ORR by BICR was also significantly higher with ADA compared with DOCE (31.9% [95% CI, 26.7–37.5] vs 9.2% [95% CI, 5.1–15.0]; odds ratio 4.68 [95% CI, 2.56–8.56]; P &lt; 0.0001); median DOR was 8.31 (95% CI, 6.05–10.35) vs 5.36 (95% CI, 2.86–8.54) mo, respectively. Treatment-related adverse events (TRAEs) were reported in 94.0% of pts treated with ADA and 86.4% with DOCE; grade ≥3 TRAEs occurred in 47.0% and 45.7% of pts, respectively. TRAEs led to discontinuation of ADA in 7.7% of pts and DOCE in 14.3%. Additional efficacy and safety analyses, including subgroup analyses, will be presented. Conclusions: In the phase 3 KRYSTAL-12 trial, ADA demonstrated a statistically significant and clinically meaningful improvement in PFS and ORR over DOCE in pts with previously treated KRASG12C-mutated NSCLC. Safety profile of ADA was consistent with previous reports and with no new safety signals. These results further support ADA as an efficacious treatment option for pts with previously treated KRASG12C-mutated locally advanced or metastatic NSCLC. Funding: Mirati, a Bristol Myers Squibb Company. Acknowledgements: KRYSTAL-12 was sponsored by Mirati, a Bristol Myers Squibb Company. Third-party medical writing support, under the direction of the authors, was provided by Flaminia Fenoaltea, MSc, of Ashfield MedComms, an Inizio company, and was funded by Mirati, a Bristol Myers Squibb Company. Clinical trial information: NCT04685135 .

Patient eligibility for trials with imaging response assessment at the time of molecular tumor board presentation

PurposeTo assess the eligibility of patients with advanced or recurrent solid malignancies presented to a molecular tumor board (MTB) at a large precision oncology center for inclusion in trials with the endpoints objective response rate (ORR) or duration of response (DOR) based on Response Evaluation Criteria in Solid Tumors (RECIST version 1.1).MethodsProspective patients with available imaging at the time of presentation in the MTB were included. Imaging data was reviewed for objectifiable measurable disease (MD) according to RECIST v1.1. Additionally, we evaluated the patients with MD for representativeness of the identified measurable lesion(s) in relation to the overall tumor burden.Results262 patients with different solid malignancies were included. 177 patients (68%) had MD and 85 (32%) had non-measurable disease (NMD) at the time point of MTB presentation in accordance with RECIST v1.1. MD was not representative of the overall tumor burden in eleven patients (6%). The main reasons for NMD were lesions with longest diameter shorter than 10 mm (22%) and non-measurable peritoneal carcinomatosis (18%). Colorectal cancer and malignant melanoma displayed the highest rates of MD (> 75%). In contrast, gastric cancer, head and neck malignancies, and ovarian carcinoma had the lowest rates of MD (< 55%). In case of MD, the measurable lesions were representative of the overall tumor burden in the vast majority of cases (94%).ConclusionApproximately one third of cancer patients with advanced solid malignancies are not eligible for treatment response assessment in trials with endpoints ORR or DOR at the time of MTB presentation. The rate of patients eligible for trials with imaging endpoints differs significantly based on the underlying malignancy and should be taken under consideration during the planning of new precision oncology trials.

Triplet combination treatments with pembrolizumab (pembro) for anti–PD-(L)1–refractory advanced melanoma: Preliminary results of the phase 1/2 KEYMAKER-U02A study.

9506 Background: Anti–PD-(L)1–refractory melanoma is a major challenge, and immunotherapy combination treatment may be useful in this patient population. The phase 1/2 KEYMAKER-U02A (NCT04305041) is a multi-arm, open-label, adaptive umbrella study designed to evaluate pembro + investigational agents for the treatment of anti–PD-(L)1–refractory melanoma. We report results from arm 1 (pembro + quavonlimab [qmab] (anti-CTLA4) + vibostolimab [vibo] (anti-TIGIT)), arm 2 [pembro + qmab + lenvatinib [len] (TKI)), and arm 3 (pembro + ATRA [all-trans retinoic acid]) of KEYMAKER-U02A. Methods: In all arms, adults had stage III/IV melanoma, ≥1 measurable lesion per RECIST v1.1, an Eastern Cooperative Oncology Group performance status score of 0 or 1, and disease progression on anti–PD-(L)1 therapy alone or in combination. Pts were randomized equally to open arms. In arm 1, pts received pembro 200 mg IV Q3W + qmab 25 mg IV Q6W + vibo 200 mg IV Q3W. In arm 2, pts received pembro 400 mg IV Q6W + qmab 25 mg IV Q6W + len 20 mg PO QD. In arm 3, pts received pembro 400 mg IV Q6W + ATRA 150 mg/m2/day PO for 3 days Q3W. Pts received treatment for up to 2 y or until intolerable toxicity, disease progression, or pt withdrawal. Primary end points were safety and ORR per RECIST v1.1 by blinded independent central review (BICR). DOR per RECIST v1.1 by BICR was the secondary end point. PFS per RECIST v1.1 by BICR and OS were exploratory end points. Enrollment was planned for a maximum of 20 pts in each arm and enrollment could continue to up to 40 pts if an ORR of &gt; 20% (5/20) was observed. Enrollment would then continue up to 100 pts if an ORR of ≥35% (14/40) was observed. Results: At data cutoff (Oct 18, 2022), 40 pts had been assigned to arms 1 and 2 and 20 pts to arm 3. Median (range) follow-up was 18.4 (1.7-24.5) mo in arm 1, 18.5 mo (1.6-25.4) in arm 2, and 2.7 mo (0.8-3.5) in arm 3. Efficacy is reported in the table. Treatment-related adverse events (TRAEs) occurred in 35 pts (88%) in arm 1, 38 pts (95%) in arm 2, and 15 pts (75%) in arm 3. Grade 3-5 TRAEs occurred in 11 pts (28%) in arm 1, 23 pts (58%) in arm 2, and 3 pts (15%) in arm 3; 1 pt in arm 2 died from a grade 5 TRAE (immune-mediated nephritis). Conclusions: Although objective responses were observed in some pts with anti–PD-(L)1–refractory melanoma, protocol-prespecified criteria for enrollment expansion were not met in any arm. The safety profile was manageable. Additional arms will be reported for this pt population with a high unmet need. Clinical trial information: NCT04305041 . [Table: see text]

Pembrolizumab (pembro) for locally advanced (LA) or recurrent/metastatic (R/M) cutaneous squamous cell carcinoma (cSCC): Long-term results of the phase 2 KEYNOTE-629 study.

9554 Background: Pembro monotherapy is approved in certain countries, including the US, for treatment of LA or R/M cSCC based on results from the open-label phase 2 KEYNOTE-629 trial (NCT03284424). Promising antitumor activity was demonstrated with pembro in both the LA and R/M cohorts. ORR (95% CI) was 50.0% (36.1-63.9; 16.7% CRs) in the LA cohort and 35.2% (26.2-45.2; 10.5% CRs) in the R/M cohort. We present data from KEYNOTE-629 with an additional follow-up of 38 mo for LA and R/M cohorts. Methods: Adults with histologically confirmed LA or R/M cSCC, measurable disease per RECIST v1.1 by blinded independent central review (BICR), and ECOG PS 0 or 1 received pembro 200 mg IV every 3 weeks for up to 35 cycles (~2 years). The primary end point was ORR per RECIST v1.1 by BICR. Secondary end points were DOR, DCR (CR + PR + SD ≥12 wks), and PFS per RECIST v1.1 by BICR; OS; and safety. End points were analyzed in pts who received ≥1 dose of pembro. Results: A total of 159 pts were treated with pembro (LA, n = 54; R/M, n = 105). As of September 13, 2023, 33 pts (20.8%) completed treatment and 126 pts (79.2%) discontinued treatment. Median (range) follow-up was 52.4 mo (47.6-56.9) for the LA cohort, 64.7 mo (62.1-69.5) for the R/M cohort, and 63.1 mo (47.6-69.5) in the total population. ORR and DCR are shown in the table. Median DOR (range) was 47.2 mo (1.0+ to 49.9+) in the LA cohort, not reached (NR; 2.7 to 64.2+ mo) in the R/M cohort, and 52.5 mo (1.0+ to 64.2+) in the total population; the proportion of responders with responses ≥12 mo by Kaplan-Meier estimate were 84.8%, 77.8%, and 80.7%, respectively. Median (95% CI) PFS was 14.4 mo (5.5-43.6) in the LA cohort, 5.7 mo (3.1-8.5) in the R/M cohort, and 8.0 mo (5.3-14.4) in the total population; 12-mo rates were 56.7%, 37.3%, and 43.7%, respectively. Median (95% CI) OS was NR (33.3-NR) in the LA cohort, 23.8 mo (13.4-30.9) in the R/M cohort, and 29.8 mo (20.0-42.8) in the total population; 36-mo rates were 62.0%, 39.5%, and 47.0%, respectively. Grade 3-5 treatment-related AEs occurred in 11.3% of pts, and grade 3-5 immune-mediated AEs and infusion reactions occurred in 8.8% of pts. Two pts (1.3%) died due to a treatment-related AE (colitis, cranial nerve disorder). Conclusions: With a median follow-up of more than 5 years, pembro continued to show durable responses in pts with LA or R/M cSCC. No new safety signals were observed. Results from this study continue to support the use of pembro in this pt population. Clinical trial information: NCT03284424 . [Table: see text]

Pembrolizumab (pembro) in patients (pts) with sorafenib-treated (cohort 1) and treatment (tx)-naive (cohort 2) advanced hepatocellular carcinoma (aHCC) after additional follow-up in the phase 2 KEYNOTE-224 study.

4100 Background: Based on the results of the open-label, phase 2 KEYNOTE-224 study (NCT02702414), pembro received US FDA and the Center for Drug Evaluation of the China National Medical Products Administration approval for pts with sorafenib-treated aHCC (cohort 1). Durable activity and manageable safety were also observed for pts with tx-naive aHCC in cohort 2 of KEYNOTE-224. We report updated efficacy and safety from both cohorts of KEYNOTE-224 after approximately 7 and 5 years of median follow-up, respectively. Methods: Adults with pathology-confirmed aHCC whose disease progressed after or who were intolerant to sorafenib tx (cohort 1) and adults with histologically, cytologically, or radiologically confirmed aHCC with no prior systemic tx (cohort 2) were eligible. Pts in both cohorts had BCLC stage C or B not amenable or refractory to locoregional therapy and not amenable to curative tx, Child-Pugh A liver function, measurable disease per RECIST v1.1, and ECOG PS 0 or 1. Pts received pembro 200 mg IV Q3W for ≤35 cycles (~2 y). Primary end point was ORR per RECIST v1.1 by BICR. Secondary end points included DOR, DCR, TTP, and PFS (all per RECIST v1.1 by BICR), OS, and safety/tolerability. Results: A total of 155 pts enrolled in cohorts 1 (n = 104) and 2 (n = 51) received ≥1 dose of pembro. Median follow-up, defined as time from first dose to data cutoff (Sept 29, 2023), was 83.0 mo (range, 79.3-87.3) for cohort 1 and 58.8 mo (range, 55.3-60.8) for cohort 2. In each cohort, 90% of pts discontinued, mostly due to progressive disease (59%); 10% of pts in each cohort completed 2 y of tx. ORR was 18.3% (95% CI, 11.4-27.1) for cohort 1 (5 CRs [4.8%] and 14 PRs [13.5%]) and 17.6% (95% CI, 8.4-30.9) for cohort 2 (2 CRs [3.9%] and 7 PRs [13.7%]). Median DOR was 21.0 mo (range, 3.1 to 75.8+) for cohort 1 and 24.7 mo (range, 3.1 to 53.4+) for cohort 2; 77%/43% and 76%/64% of responders, respectively, had a response duration of ≥12 mo/≥24 mo per the Kaplan-Meier method for censored data. Data for PFS, TTP, and OS are shown in the Table. Tx-related AEs were reported in 76 pts (73.1%; grade 3-5, 27 [26.0%]) in cohort 1 and 28 pts (54.9%; grade 3-5, 8 [15.7%]) in cohort 2. Conclusions: Pembro continued to provide durable responses in pts with aHCC with or without prior systemic therapy, with some lasting beyond 20 mo; long-term effects on OS beyond 24 mo and manageable safety were also observed. Together with data from KEYNOTE-394 and KEYNOTE-240, these data support the efficacy and safety of pembro as a tx option for aHCC. Clinical trial information: NCT02702414 . [Table: see text]

Efficacy, safety, and patient-reported outcomes of vimseltinib in patients with tenosynovial giant cell tumor: Results from the phase 3 MOTION trial.

11500 Background: Tenosynovial giant cell tumor (TGCT) is a locally aggressive neoplasm caused by dysregulation of the colony-stimulating factor 1 ( CSF1) gene leading to overproduction of CSF1. TGCT requires a therapy with low toxicity as patients (pts) may need long-term treatment; there is an unmet need for an effective, well-tolerated CSF1 receptor (CSF1R)-targeted therapy that improves functional health and quality of life (QoL). Vimseltinib is an investigational, oral, switch-control tyrosine kinase inhibitor specifically designed to selectively and potently inhibit CSF1R. Here we report results from the MOTION trial. Methods: MOTION is a global, phase 3, double-blind study of vimseltinib in pts with symptomatic TGCT not amenable to surgery (NCT05059262). Randomization was 2:1 to vimseltinib 30 mg twice weekly or matching placebo (pbo) for 24 weeks. The primary endpoint was objective response rate (ORR) assessed by blinded independent radiological review (IRR) per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) at week 25. Key secondary endpoints assessed at week 25 were ORR by IRR per tumor volume score (TVS), change from baseline in active range of motion (ROM) of the affected joint and patient-reported outcomes (PROs; PRO Measurement Information System physical function score [PROMIS-PF], worst stiffness numeric rating scale, and EuroQol Visual Analog Scale [EQ-VAS]), and brief pain inventory worst pain response. Safety was also evaluated. Data cutoff was August 22, 2023. Results: Overall, 123 pts were randomized to vimseltinib (n = 83) or pbo (n = 40). Median age was 44 years, 59% of pts were female, and the most common primary disease location was the knee (67%). ORR at week 25 by IRR per RECIST v1.1 and per TVS were significantly higher for vimseltinib vs pbo (RECIST: 40% vs 0%, P &lt; 0.0001; TVS: 67% vs 0%; P &lt; 0.0001). Significant improvements from baseline to week 25 were observed with vimseltinib vs pbo in active ROM (18.4% vs 3.8%; P = 0.0077), physical function (PROMIS-PF: 3.3-point difference between arms, P = 0.0007), worst stiffness (−1.8-point difference, P &lt; 0.0001), and health status (EQ-VAS: 7.4-point difference, P = 0.0155). There were also significantly more pain responders treated with vimseltinib (48% vs 23%; P = 0.0056). Most non-laboratory treatment-emergent adverse events were grade 1/2, and there was no evidence of cholestatic hepatotoxicity or drug-induced liver injury. Conclusions: Patients treated with vimseltinib experienced statistically significant and clinically meaningful improvements in ORR by RECIST v1.1 and by TVS, active ROM, physical function, stiffness, health status, and pain vs pbo. Vimseltinib is an effective, well-tolerated CSF1R-targeted therapy that demonstrates significant clinical benefit and improves functional health and QoL in pts with symptomatic TGCT not amenable to surgery. Clinical trial information: NCT05059262 .

STELLAR-305: A randomized phase 2/3 study of zanzalintinib plus pembrolizumab versus pembrolizumab alone in patients with previously untreated PD-L1 positive recurrent/metastatic head and neck squamous cell carcinoma.

TPS6114 Background: VEGFR, MET, and the TAM kinase AXL are overexpressed in recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC); their activation contributes to increased tumor aggressiveness and poor prognosis. The immune checkpoint inhibitor (ICI) pembrolizumab, as monotherapy or in combination with chemotherapy, is a standard of care in patients with PD-L1 expressing R/M HNSCC. However, the response rate and survival benefit with pembrolizumab monotherapy are unsatisfactory, and addition of chemotherapy results in unfavorable toxicity. Zanzalintinib is a novel, multi-targeted tyrosine kinase inhibitor (TKI) of VEGFR, MET, and the TAM kinases (TYRO3, AXL, MER). Preclinical data suggest zanzalintinib-mediated inhibition of these kinases may suppress tumor growth and angiogenesis, while simultaneously promoting an immune-permissive tumor microenvironment that may enhance response to ICIs. Zanzalintinib + ICI combination has shown promising antitumor activity and manageable safety in a phase 1 study in solid tumors. To further support the TKI-ICI combination, phase 2 clinical activity was observed in R/M HNSCC with the multi-targeted TKI cabozantinib (inhibits VEGFR, MET, and TAM kinases) in combination with pembrolizumab. The present study, STELLAR-305, will evaluate the efficacy and safety of zanzalintinib + pembrolizumab vs pembrolizumab alone in previously untreated, PD-L1-positive, R/M HNSCC. Methods: STELLAR-305 (NCT06082167) is a randomized, double-blind, phase 2/3 study. Eligible patients are adults (≥18 years) with histologically or cytologically confirmed R/M HNSCC that is incurable with local therapy. Patients may not have been treated with systemic therapy, unless given as part of multimodal treatment for locally advanced disease and completed &gt;6 months before randomization. Patients must have a primary tumor location of the oropharynx (HPV testing required), oral cavity, hypopharynx, or larynx; those with nasopharynx, salivary gland, or occult primary sites are excluded. Other eligibility criteria include a PD-L1 CPS ≥1, measurable disease per RECIST v1.1, and an ECOG performance status of 0–1. Patients with prior treatment with ICIs or zanzalintinib are not eligible. Patients will be randomized 1:1 to zanzalintinib + pembrolizumab, or placebo + pembrolizumab. The dual primary endpoints are PFS per RECIST v1.1 by blinded independent radiology committee and overall survival. Secondary endpoints include safety, PFS per RECIST v1.1 by investigator, objective response rate, and duration of response. If minimum efficacy requirements are met in phase 2, the study will proceed to phase 3 with approximately 500 patients enrolled across both phases. STELLAR-305 is currently enrolling, with 200 sites estimated for global expansion. Clinical trial information: NCT06082167 .

Phase 1 study of anti–immunoglobulin-like transcript 3 (ILT3) monoclonal antibody MK-0482 + pembrolizumab + gemcitabine + nab-paclitaxel (Gem/Nab-P) in patients (pts) with metastatic pancreatic ductal adenocarcinoma (mPDAC).

4139 Background: Standard first-line treatment of mPDAC includes Gem/Nab-P doublet therapy, which typically results in an ORR of 23%-35%, a median PFS of 5-6 mo, and a median OS of 7-10 mo. ILT3 is an inhibitory receptor expressed on monocytic myeloid cells, including tolerogenic dendritic cells and myeloid-derived suppressor cells. MK-0482 is a novel humanized IgG4 monoclonal antibody targeting ILT3. ILT3 inhibition with MK-0482 has the potential to relieve immunosuppression within the tumor microenvironment. In the expansion cohort of the first-in-human phase 1 study MK-0482-001 (NCT03918278), the combination of MK-0482 + pembrolizumab + Gem/Nab-P was evaluated in pts with treatment-naive mPDAC. The safety and efficacy data from this cohort are presented. Methods: Pts aged ≥18 y with previously untreated mPDAC, measurable disease per RECIST v1.1, and an ECOG PS of 0 or 1 received MK-0482 750 mg Q3W + pembrolizumab 200 mg Q3W IV for ≤35 cycles + Gem/Nab-P (gemcitabine 1000 mg/m2; nab-paclitaxel 125 mg/m2) on days 1, 8, and 15 Q4W until PD or treatment discontinuation. The primary end point was safety. Secondary end points were ORR, DCR (CR + PR + SD), and DOR by investigator assessment per RECIST v1.1. Exploratory end points included PFS per RECIST v1.1 and OS. Results: A total of 37 pts were enrolled and received study treatment. At data cutoff (Oct 3, 2023), median follow-up was 13 mo (range 8.9-18.9). Median age was 65 y (range, 39-77). Most pts were male (54%), had an ECOG PS 1 (65%), and had ≥3 sites of metastasis (54%). Any-cause adverse events (AEs) occurred in all pts and treatment-related AEs (TRAEs) occurred in 36 pts (97%). Grade 3 or 4 TRAEs occurred in 27 pts (73%); the most frequent (≥10%) were decreased neutrophil count (27%), anemia (19%), and neutropenia (19%). No deaths due to TRAEs occurred. Immune-mediated AEs occurred in 12 pts (32%); the most frequent (≥10%) was hypothyroidism (11%). Grade 3 immune-mediated AEs occurred in 5 pts (14%; hepatitis, n = 2; severe skin reactions, n = 2; colitis, n = 1); no grade 4 or 5 events occurred. Confirmed ORR was 43% (16/37; 95% CI, 27.1-60.5), DCR was 84% (31/37; 68.0-93.8), and median DOR was 8.5 mo (range, 3.7-17.8+). Median PFS was 8.5 mo (95% CI, 5.7-12.3) and median OS was 15.6 mo (10.5-22.1); 12-mo PFS and OS rates were 35% and 60%, respectively. Biomarker data will be included in the presentation. Conclusions: MK-0482 + pembrolizumab + Gem/Nab-P showed a manageable AE profile in patients with treatment-naive mPDAC, which was generally consistent with the combined safety profiles of pembrolizumab-based immunotherapy and Gem/Nab-P, respectively. The 4-drug combination showed increased clinical efficacy compared with that historically observed for chemotherapy regimens. Further evaluation is needed to confirm the clinical activities observed. Clinical trial information: NCT03918278 .

Krascendo-170 Lung: A phase Ib/II study of divarasib + pembrolizumab ± platinum-based chemotherapy and pemetrexed in untreated KRAS G12C+advanced non-small cell lung cancer (NSCLC).

TPS8651 Background: The KRAS G12C mutation, present in ~12% of NSCLC patients, drives oncogenic signaling and cancer formation and is associated with poor prognosis. The current first-line treatment for advanced KRAS G12C+ NSCLC is checkpoint inhibitor (CPI) ± chemotherapy (CT). Novel combinations using a more targeted, biomarker-directed approach are supported by pre-clinical evidence and may further improve outcomes. Divarasib is an oral KRAS G12C inhibitor with potent pre-clinical and clinical anti-tumor activity. We hypothesize that divarasib + CPI ± CT may improve outcomes for patients with KRAS G12C+ NSCLC. Methods: Krascendo-170 Lung (NCT05789082) is a phase Ib/II, open-label study evaluating the safety and activity of divarasib + pembrolizumab in patients with PD-L1 tumor cell expression ≥1% (Cohort A) and of divarasib + pembrolizumab with platinum-based CT and pemetrexed in patients with any PD-L1 tumor cell expression level (Cohort B). Patients must be ≥18 years old with untreated unresectable/metastatic non-squamous NSCLC (measurable per RECIST v1.1), a confirmed KRASG12C mutation, and an Eastern Cooperative Oncology Group performance status 0/1. Each cohort will have two stages: divarasib combination dose finding and dose expansion, with two planned dose levels of divarasib (Table). Tumor assessments will be performed at baseline and every 6 weeks for 48 weeks, then every 9 weeks thereafter. Plasma samples will be taken at various timepoints before and after divarasib and pembrolizumab dosing to characterize pharmacokinetics. Patients will be treated until disease progression per RECIST v1.1 or unacceptable toxicity. The co-primary endpoints are adverse events and change from baseline in targeted safety parameters. Key secondary endpoints include objective response rate, progression-free survival and duration of response (all investigator assessed per RECIST v1.1). Enrollment into the combination dose finding stage of Cohort A has been completed without dose-limiting toxicities and enrollment into the dose expansion stage is continuing. Clinical trial information: NCT05789082 . [Table: see text]

A phase 2 trial of IO102-IO103 and nivolumab-relatlimab fixed-dose combination in previously untreated, unresectable melanoma.

TPS9605 Background: One emerging strategy to augment immune checkpoint inhibitor efficacy is to eliminate immunosuppressive cell populations in the tumor microenvironment (TME) through vaccination. IO102-IO103 is an investigational cancer vaccine that targets both tumor and immune-suppressive cells in the TME. IO102-IO103 treatment promotes inflammation and potentiates anti-tumor activity via activation and expansion of T cells against IDO1 and/or PD-L1 positive cells. IO102-IO103 plus nivolumab demonstrated an impressive objective response rate (ORR) of 80% in the phase 1/2 MM1636 trial of 30 patients with previously untreated, unresectable melanoma, and a randomized phase 3 trial of pembrolizumab with or without IO102-IO103 (NCT05155254) is ongoing. No prior studies have evaluated IO102-IO103 in combination with dual PD-1 and LAG-3 blockade with nivolumab-relatlimab (nivo-rela), and to our knowledge there are no existing clinical data for other investigational agents in combination with nivo-rela. Methods: NCT05912244 is a single-arm, investigator-initiated trial testing IO102-IO103 in combination with nivo-rela in patients with previously untreated, unresectable melanoma. Twelve of forty-three planned patients have been enrolled. All patients will be treated with nivo-rela every four weeks for up to two years. IO102-IO103 will be administered subcutaneously every two weeks for the initial eight weeks, and then every four weeks for up to two years. An interim efficacy analysis for futility will be performed after response data are available for 21 patients. Eligible patients must have histologically confirmed, unresectable stage III or stage IV non-uveal melanoma, measurable disease by RECIST v1.1, an ECOG performance status of 0 or 1, and definitive treatment of any brain metastases. Prior systemic treatment in the neoadjuvant or adjuvant setting is allowed if completed at least six months prior to trial enrollment. Available pre-treatment melanoma tissue is required, and all patients will undergo an on-treatment study biopsy between the second and third dose of nivo-rela. Peripheral blood mononuclear cells will be collected prior to the first three doses of nivo-rela. The primary endpoint is ORR by RECIST v1.1, weighted by PD-L1 expression. Secondary endpoints include safety assessed by Common Terminology Criteria for Adverse Events v 5.0, progression-free survival (PFS) by RECIST v1.1, duration of disease response, and disease control rate. Exploratory correlative endpoints include assessment of changes in PD-L1 and IDO-expressing cells in the TME on paired tumor biopsies, identification of peripheral PD-L1 and IDO-reactive cells in the peripheral blood by ELISpot, and assessment of peripheral pre-treatment and on-treatment T cell clonality by TCR sequencing. Clinical trial information: NCT05912244 .

LUNAR-2: Pivotal, randomized, open-label study of tumor treating fields (TTFields, 150 kHz) concomitant with pembrolizumab and platinum based chemotherapy for the treatment of metastatic non-small cell lung cancer.

TPS8665 Background: Tumor Treating Fields (TTFields) are electric fields that disrupt processes critical for cancer cell viability. TTFields are delivered by a noninvasive portable device that has the European CE Mark and FDA approval for glioblastoma and mesothelioma. Preclinical non-small cell lung cancer (NSCLC) studies demonstrated that TTFields enhance the antitumor immune response, through disruption of mitosis and subsequent induction of immunogenic cell death. The pivotal, phase III LUNAR study (NCT02973789) in metastatic NSCLC progressing on/after platinum-based therapy demonstrated that TTFields with an immune checkpoint inhibitor (ICI) or docetaxel provided a statistically significant and clinically meaningful 3.3-month improvement in median overall survival (OS) vs an ICI or docetaxel alone, with no added systemic toxicities and no clinically significant difference on quality of life between groups. Despite advances in the treatment of NSCLC, survival rates for stage IV disease remain poor and there is a need for effective and tolerable treatments. Methods: LUNAR-2 (NCT06216301) is a pivotal, global, randomized, trial investigating the efficacy and safety of TTFields concomitant with pembrolizumab (P) and platinum-based chemotherapy (C) in patients (pts) with metastatic NSCLC, with a planned enrollment of 734 pts at 134 sites. Pts with NSCLC, radiologically evaluable disease in the thorax, ECOG PS of 0–1, and no prior treatment for metastatic disease are eligible. Pts will be stratified by histology, PD-L1 Tumor Proportion Score (TPS) and prior treatment with immunotherapy. Randomization is 1:1 to TTFields/P+C or P+C alone. Standard doses of P+C will be administered to both arms on day 1 of a 21-day cycle for 4 cycles of induction followed by up to 31 cycles of maintenance with TTFields/P or P alone. TTFields generated by the NovoTTF-200T System, will be delivered to the thorax ≥ 18 h/day until local disease progression per iRECIST. The primary endpoints are OS and progression-free survival (PFS) per RECIST v1.1 as assessed by a blinded independent central review (BICR). Secondary endpoints include OS and PFS according to histology or PD-L1 TPS, objective response rate, duration of response, and disease control rate, all per RECIST v1.1 as assessed by BICR and by investigator, comparing TTFields/P+C vs. P+C alone. Other secondary endpoints include PFS rates at 6, 12, 24 and 36 months per RECIST v1.1 as assessed by BICR, 1-, 2-, and 3-year survival rates and safety. Device Support Specialists will provide technical and lifestyle integration training for pts and caregivers throughout TTFields therapy. Pts usage is tracked by the device and is provided to pts and physicians to facilitate discussions to optimize outcomes by maximizing time on therapy. The trial is currently recruiting. Clinical trial information: NCT06216301 .