度伐鲁单抗联合帕唑帕尼治疗晚期软组织肉瘤患者的 II 期临床试验。

Durvalumab plus pazopanib combination in patients with advanced soft tissue sarcomas: a phase II trial.

机构信息

Department of Biomedical Convergence Science and Technology, CMRI, Kyungpook National University, Daegu, Republic of Korea.

Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.

出版信息

Nat Commun. 2024 Jan 23;15(1):685. doi: 10.1038/s41467-024-44875-2.

Abstract

We aimed to determine the activity of the anti-VEGF receptor tyrosine-kinase inhibitor, pazopanib, combined with the anti-PD-L1 inhibitor, durvalumab, in metastatic and/or recurrent soft tissue sarcoma (STS). In this single-arm phase 2 trial (NCT03798106), treatment consisted of pazopanib 800 mg orally once a day and durvalumab 1500 mg once every 3 weeks. Primary outcome was overall response rate (ORR) and secondary outcomes included progression-free survival (PFS), overall survival, disease control rate, immune-related response criteria, and safety. The ORR was 30.4% and the trial met the pre-specified endpoint. The median PFS was 7.7 months (95% confidence interval: 5.7-10.4). The common treatment-related adverse events of grades 3-4 included neutropenia (9 [19.1%]), elevated aspartate aminotransferase (7 [14.9%]), alanine aminotransferase (5 [10.6%]), and thrombocytopenia (4 [8.5%]). In a prespecified transcriptomic analysis, the B lineage signature was a significant key determinant of overall response (P = 0.014). In situ analysis also showed that tumours with high CD20 B cell infiltration and vessel density had a longer PFS (P = 6.5 × 10) than those with low B cell infiltration and vessel density, as well as better response (50% vs 12%, P = 0.019). CD20 B cell infiltration was identified as the only independent predictor of PFS via multivariate analysis. Durvalumab combined with pazopanib demonstrated promising efficacy in an unselected STS cohort, with a manageable toxicity profile.

摘要

我们旨在确定抗血管内皮生长因子受体酪氨酸激酶抑制剂帕唑帕尼与抗 PD-L1 抑制剂度伐鲁单抗联合用于转移性和/或复发性软组织肉瘤(STS)的疗效。在这项单臂 2 期试验(NCT03798106)中,治疗包括每天口服帕唑帕尼 800mg 和每 3 周静脉注射度伐鲁单抗 1500mg。主要终点是总缓解率(ORR),次要终点包括无进展生存期(PFS)、总生存期、疾病控制率、免疫相关反应标准和安全性。ORR 为 30.4%,试验达到了预设的终点。中位 PFS 为 7.7 个月(95%置信区间:5.7-10.4)。常见的 3-4 级治疗相关不良事件包括中性粒细胞减少症(9 [19.1%])、天门冬氨酸氨基转移酶升高(7 [14.9%])、丙氨酸氨基转移酶升高(5 [10.6%])和血小板减少症(4 [8.5%])。在一项预设的转录组分析中,B 细胞谱系特征是总缓解的一个重要关键决定因素(P=0.014)。原位分析还显示,CD20 阳性 B 细胞浸润和血管密度高的肿瘤比 CD20 阳性 B 细胞浸润和血管密度低的肿瘤具有更长的 PFS(P=6.5×10)和更好的反应(50%比 12%,P=0.019)。CD20 阳性 B 细胞浸润是通过多变量分析确定的唯一独立的 PFS 预测因子。度伐鲁单抗联合帕唑帕尼在未选择的 STS 患者中显示出有希望的疗效,且毒性谱可管理。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d8fe/10806253/e71f21a477ea/41467_2024_44875_Fig1_HTML.jpg

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