Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts.
Clin Cancer Res. 2021 Feb 15;27(4):983-991. doi: 10.1158/1078-0432.CCR-20-3089. Epub 2020 Nov 30.
PURPOSE: We report results from a phase II study assessing the efficacy of the WEE1 inhibitor adavosertib with cisplatin in metastatic triple-negative breast cancer (mTNBC). PATIENTS AND METHODS: Patients with mTNBC treated with 0-1 prior lines of chemotherapy received cisplatin 75 mg/m i.v. followed 21 days later by cisplatin plus adavosertib 200 mg oral twice daily for five doses every 21 days. The study had 90% power to detect the difference between null (20%) and alternative (40%) objective response rates (ORR) with a one-sided type I error of 0.1: an ORR >30% was predefined as making the regimen worthy of further study. RNA sequencing and multiplex cyclic immunofluorescence on pre- and post-adavosertib tumor biopsies, as well as targeted next-generation sequencing on archival tissue, were correlated with clinical benefit, defined as stable disease ≥6 months or complete or partial response. RESULTS: A total of 34 patients initiated protocol therapy; median age was 56 years, 2 patients (6%) had mutations, and 14 (41%) had one prior chemotherapy. ORR was 26% [95% confidence interval (CI), 13-44], and median progression-free survival was 4.9 months (95% CI, 2.3-5.7). Treatment-related grade 3-5 adverse events occurred in 53% of patients, most commonly diarrhea in 21%. One death occurred because of sepsis, possibly related to study therapy. Tumors from patients with clinical benefit demonstrated enriched immune gene expression and T-cell infiltration. CONCLUSIONS: Among patients with mTNBC treated with 0-1 prior lines, adavosertib combined with cisplatin missed the prespecified ORR cutoff of >30%. The finding of immune-infiltrated tumors in patients with clinical benefit warrants validation.
目的:我们报告了一项评估 WEE1 抑制剂adavosertib 联合顺铂治疗转移性三阴性乳腺癌(mTNBC)疗效的 II 期研究结果。
患者和方法:接受过 0-1 线化疗的 mTNBC 患者接受静脉注射顺铂 75mg/m2,21 天后给予顺铂加 adavosertib 200mg 口服,每日两次,每 21 天 5 个剂量。该研究有 90%的效能检测零假设(20%)和替代假设(40%)客观缓解率(ORR)之间的差异,单侧Ⅰ型错误为 0.1:定义 ORR>30%为使方案值得进一步研究。在使用 adavosertib 前后对肿瘤活检进行 RNA 测序和多重循环免疫荧光,以及对存档组织进行靶向下一代测序,与临床获益相关,定义为疾病稳定≥6 个月或完全或部分缓解。
结果:共有 34 例患者开始接受方案治疗;中位年龄为 56 岁,2 例(6%)有 突变,14 例(41%)有一线化疗。ORR 为 26%[95%置信区间(CI),13-44],中位无进展生存期为 4.9 个月(95%CI,2.3-5.7)。53%的患者发生了治疗相关的 3-5 级不良事件,最常见的是腹泻(21%)。1 例死亡是由于败血症,可能与研究治疗有关。有临床获益的患者的肿瘤显示免疫基因表达和 T 细胞浸润丰富。
结论:在接受 0-1 线化疗的 mTNBC 患者中,adavosertib 联合顺铂未达到>30%的预设 ORR 截止值。在有临床获益的患者中发现浸润性肿瘤的免疫浸润,需要进一步验证。
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