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Safety and Clinical Activity of the Programmed Death-Ligand 1 Inhibitor Durvalumab in Combination With Poly (ADP-Ribose) Polymerase Inhibitor Olaparib or Vascular Endothelial Growth Factor Receptor 1-3 Inhibitor Cediranib in Women's Cancers: A Dose-Escalation, Phase I Study

Journal of clinical oncology, 2017-07, Vol.35 (19), p.2193-2202 [Peer Reviewed Journal]

2017 by American Society of Clinical Oncology 2017 American Society of Clinical Oncology ;ISSN: 0732-183X ;EISSN: 1527-7755 ;DOI: 10.1200/JCO.2016.72.1340 ;PMID: 28471727

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Title:
Safety and Clinical Activity of the Programmed Death-Ligand 1 Inhibitor Durvalumab in Combination With Poly (ADP-Ribose) Polymerase Inhibitor Olaparib or Vascular Endothelial Growth Factor Receptor 1-3 Inhibitor Cediranib in Women's Cancers: A Dose-Escalation, Phase I Study
Author: Lee, Jung-Min ; Cimino-Mathews, Ashley ; Peer, Cody J ; Zimmer, Alexandra ; Lipkowitz, Stanley ; Annunziata, Christina M ; Cao, Liang ; Harrell, Maria I ; Swisher, Elizabeth M ; Houston, Nicole ; Botesteanu, Dana-Adriana ; Taube, Janis M ; Thompson, Elizabeth ; Ogurtsova, Aleksandra ; Xu, Haiying ; Nguyen, Jeffers ; Ho, Tony W ; Figg, William D ; Kohn, Elise C
Subjects: Adult ; Aged ; Antibodies, Monoclonal - administration & dosage ; Antibodies, Monoclonal - adverse effects ; Antibodies, Monoclonal - pharmacokinetics ; Antineoplastic Combined Chemotherapy Protocols - adverse effects ; Antineoplastic Combined Chemotherapy Protocols - pharmacokinetics ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; B7-H1 Antigen - antagonists & inhibitors ; B7-H1 Antigen - biosynthesis ; B7-H1 Antigen - immunology ; Breast Cancer ; Combined Modality ; Dose-Response Relationship, Drug ; Female ; Genital Neoplasms, Female - drug therapy ; Genital Neoplasms, Female - immunology ; Genital Neoplasms, Female - metabolism ; Genital Neoplasms, Female - pathology ; Humans ; Lymphocytes, Tumor-Infiltrating - immunology ; Middle Aged ; ORIGINAL REPORTS ; Phase I and Clinical Pharmacology ; Phthalazines - administration & dosage ; Phthalazines - adverse effects ; Phthalazines - pharmacokinetics ; Piperazines - administration & dosage ; Piperazines - adverse effects ; Piperazines - pharmacokinetics ; Poly(ADP-ribose) Polymerase Inhibitors - administration & dosage ; Protein Kinase Inhibitors - administration & dosage ; Protein Kinase Inhibitors - adverse effects ; Quinazolines - administration & dosage ; Quinazolines - adverse effects ; Quinazolines - pharmacokinetics ; Vascular Endothelial Growth Factor Receptor-1 - antagonists & inhibitors
Is Part Of: Journal of clinical oncology, 2017-07, Vol.35 (19), p.2193-2202
Description: Purpose Data suggest that DNA damage by poly (ADP-ribose) polymerase inhibition and/or reduced vascular endothelial growth factor signaling by vascular endothelial growth factor receptor inhibition may complement antitumor activity of immune checkpoint blockade. We hypothesize the programmed death-ligand 1 (PD-L1) inhibitor, durvalumab, olaparib, or cediranib combinations are tolerable and active in recurrent women's cancers. Patients and Methods This phase I study tested durvalumab doublets in parallel 3 + 3 dose escalations. Durvalumab was administered at 10 mg/kg every 2 weeks or 1,500 mg every 4 weeks with either olaparib tablets twice daily or cediranib on two schedules. The primary end point was the recommended phase II dose (RP2D). Response rate and pharmacokinetic analysis were secondary end points. Results Between June 2015 and May 2016, 26 women were enrolled. The RP2D was durvalumab 1,500 mg every 4 weeks with olaparib 300 mg twice a day, or cediranib 20 mg, 5 days on/2 days off. No dose-limiting toxicity was recorded with durvalumab plus olaparib. The cediranib intermittent schedule (n = 6) was examined because of recurrent grade 2 and non-dose-limiting toxicity grade 3 and 4 adverse events (AEs) on the daily schedule (n = 8). Treatment-emergent AEs included hypertension (two of eight), diarrhea (two of eight), pulmonary embolism (two of eight), pulmonary hypertension (one of eight), and lymphopenia (one of eight). Durvalumab plus intermittent cediranib grade 3 and 4 AEs were hypertension (one of six) and fatigue (one of six). Exposure to durvalumab increased cediranib area under the curve and maximum plasma concentration on the daily, but not intermittent, schedules. Two partial responses (≥15 months and ≥ 11 months) and eight stable diseases ≥ 4 months (median, 8 months [4 to 14.5 months]) were seen in patients who received durvalumab plus olaparib, yielding an 83% disease control rate. Six partial responses (≥ 5 to ≥ 8 months) and three stable diseases ≥ 4 months (4 to ≥ 8 months) were seen in 12 evaluable patients who received durvalumab plus cediranib, for a 50% response rate and a 75% disease control rate. Response to therapy was independent of PD-L1 expression. Conclusion To our knowledge, this is the first reported anti-PD-L1 plus olaparib or cediranib combination therapy. The RP2Ds of durvalumab plus olaparib and durvalumab plus intermittent cediranib are tolerable and active. Phase II studies with biomarker evaluation are ongoing.
Publisher: United States: American Society of Clinical Oncology
Language: English
Identifier: ISSN: 0732-183X
EISSN: 1527-7755
DOI: 10.1200/JCO.2016.72.1340
PMID: 28471727
Source: Geneva Foundation Free Medical Journals at publisher websites
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Safety and Clinical Activity of the Programmed Death-Ligand 1 Inhibitor Durvalumab in Combination With Poly (ADP-Ribose) Polymerase Inhibitor Olaparib or Vascular Endothelial Growth Factor Receptor 1-3 Inhibitor Cediranib in Women's Cancers: A Dose-Escalation, Phase I Study

2017 by American Society of Clinical Oncology 2017 American Society of Clinical Oncology ;ISSN: 0732-183X ;EISSN: 1527-7755 ;DOI: 10.1200/JCO.2016.72.1340 ;PMID: 28471727

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