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威罗菲尼联合顺铂治疗转移性三阴性乳腺癌的临床疗效和分子反应相关性研究

Clinical Efficacy and Molecular Response Correlates of the WEE1 Inhibitor Adavosertib Combined with Cisplatin in Patients with Metastatic Triple-Negative Breast Cancer.

机构信息

Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.

Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts.

出版信息

Clin Cancer Res. 2021 Feb 15;27(4):983-991. doi: 10.1158/1078-0432.CCR-20-3089. Epub 2020 Nov 30.


DOI:10.1158/1078-0432.CCR-20-3089
PMID:33257427
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7887044/
Abstract

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.

摘要

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。

相似文献

[1]
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本文引用的文献

[1]
Phase II Study of the WEE1 Inhibitor Adavosertib in Recurrent Uterine Serous Carcinoma.

J Clin Oncol. 2021-5-10

[2]
A Biomarker-enriched, Randomized Phase II Trial of Adavosertib (AZD1775) Plus Paclitaxel and Carboplatin for Women with Platinum-sensitive -mutant Ovarian Cancer.

Clin Cancer Res. 2020-9-15

[3]
Phase I Clinical Trial of the Wee1 Inhibitor Adavosertib (AZD1775) with Irinotecan in Children with Relapsed Solid Tumors: A COG Phase I Consortium Report (ADVL1312).

Clin Cancer Res. 2020-3-15

[4]
The Cytosolic DNA-Sensing cGAS-STING Pathway in Cancer.

Cancer Discov. 2020-1

[5]
Development and Characterization of a Wee1 Kinase Degrader.

Cell Chem Biol. 2020-1-16

[6]
The genomic landscape of metastatic breast cancer highlights changes in mutation and signature frequencies.

Nat Genet. 2019-9-30

[7]
Dose Escalation Trial of the Wee1 Inhibitor Adavosertib (AZD1775) in Combination With Gemcitabine and Radiation for Patients With Locally Advanced Pancreatic Cancer.

J Clin Oncol. 2019-8-9

[8]
Determining cell type abundance and expression from bulk tissues with digital cytometry.

Nat Biotechnol. 2019-5-6

[9]
Insights into Molecular Classifications of Triple-Negative Breast Cancer: Improving Patient Selection for Treatment.

Cancer Discov. 2019-1-24

[10]
Next-Generation Sequencing Identifies Novel RTK VUSs in Breast Cancer with an Emphasis on ROS1, ERBB4, ALK and NTRK3.

Pathol Oncol Res. 2020-1

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