Pexidartinib (Pex) for locally advanced tenosynovial giant cell tumour (TGCT): Characterization of hepatic adverse reactions (ARs)

Pexidartinib (Pex) for locally advanced tenosynovial giant cell tumour (TGCT): Characterization of hepatic adverse reactions (ARs)

abstracts Annals of Oncology 1696P Pexidartinib (Pex) for locally advanced tenosynovial giant cell tumour (TGCT): Characterization of hepatic adver...

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abstracts

Annals of Oncology

1696P

Pexidartinib (Pex) for locally advanced tenosynovial giant cell tumour (TGCT): Characterization of hepatic adverse reactions (ARs)

Background: TGCT is a rare, locally aggressive neoplasm of the joint/tendon sheath associated with colony-stimulating factor 1 (CSF1) overexpression. No systemic therapy is approved. Pex, a selective inhibitor of CSF1 receptor, KIT, and FLT3-ITD, showed tumor responses in TGCT in 3 phase I studies, and significant response by Response Evaluation Criteria in Solid Tumors v1.1 (39% vs 0%; P < 0.0001) and improved functional outcomes vs placebo in a phase III study (ENLIVEN, NCT02371369). Here we report treatment-emergent hepatic ARs across TGCT studies. Methods: Patients (pts) 18 y had symptomatic, unresectable TGCT; surgery was not recommended and/or was associated with potentially worse function or severe morbidity. Hepatic ARs were assessed by type and magnitude of liver test abnormalities. Results: In 130 pts assessed for hepatic ARs from the ENLIVEN and phase I extension (PLX108-01, NCT01004861) studies, mean Pex duration was 75 wk (range, 2.14259.14); 10 additional Pex-treated pts from 2 other phase I studies are included in the table (N ¼ 140). Hepatic ARs were of 2 types: (1) aminotransferase elevations, which were frequent, dose-dependent, and related to CSF1 receptor inhibition, and (2) mixed or cholestatic hepatotoxicity, which was uncommon, idiosyncratic, and rarely serious (Table). All serious hepatic ARs developed in the first 8 wk of treatment. Four serious but nonfatal mixed and cholestatic cases with increased bilirubin (1 ductopenia) resolved after 1-7 mo. In non-TGCT pts (N ¼ 658), 2 severe cases of liver toxicity (1 leading to liver transplant, 1 death with ongoing cholestasis and tumor progression) were observed with Pex. Conclusions: Pex is the first systemic therapy assessed in a randomized placebo-controlled study showing significantly improved tumor response and clinical benefit in locally advanced TGCT. With liver test monitoring, Pex may offer a relevant treatment option for select pts with symptomatic TGCT. Clinical trial identification: NCT02371369, NCT02734433, NCT03291288, NCT01004861. Editorial acknowledgement: Phillip Giannopoulos, PhD, SciStrategy Communications. Legal entity responsible for the study: Overall abstract: Daiichi Sankyo, Inc. Individual studies: NCT02371369 – Daiichi Sankyo, Inc., NCT01004861 – Plexxikon Inc., NCT02734433 – Daiichi Sankyo Co., Ltd., NCT03291288 – Daiichi Sankyo, Inc. Funding: Overall abstract funded by Daiichi Sankyo, Inc. Individual studies: NCT02371369 – Daiichi Sankyo, Inc., NCT01004861 – Plexxikon Inc., NCT02734433 – Daiichi Sankyo Co., Ltd., NCT03291288 – Daiichi Sankyo, Inc. Disclosure: S. Bauer: Advisory / Consultancy, Research grant / Funding (self): Blueprint Medicines; Advisory / Consultancy: Deciphera; Advisory / Consultancy, Research grant / Funding (institution): Novartis; Honoraria (self): PharmaMar; Advisory / Consultancy: ADC Therapeutics; Advisory / Consultancy, CME-educational presentations: Lilly; Advisory / Consultancy: Janssen-Cilag; Advisory / Consultancy: Bayer; Advisory / Consultancy: Daiichi Sankyo; Advisory / Consultancy: Nanobiotix; Research grant / Funding (self), Investigator-initiated trial: Incyte; Officer / Board of Directors, Member of External Advisory Board for "Off-label use in oncology": Federal Ministry of Health. J.H. Lewis: Advisory / Consultancy, Travel / Accommodation / Expenses: Daiichi Sankyo; Speaker Bureau / Expert testimony, Travel / Accommodation / Expenses: Gilead. H. Gelderblom: Research grant / Funding (institution), Licensing / Royalties: Daiichi Sankyo; Licensing / Royalties: Boehringer Ingelheim; Licensing / Royalties: Pfizer; Licensing / Royalties: Novartis; Licensing / Royalties: PharmaMar; Licensing / Royalties: Five Prime; Licensing / Royalties: Amgen. M. van de Sande: Advisory / Consultancy, Research grant / Funding (institution): Daiichi Sankyo. S. Stacchiotti: Honoraria (self): Takeda; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Lilly; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): PharmaMar; Advisory / Consultancy, Research grant / Funding (institution): Bayer; Advisory / Consultancy, Research grant / Funding (institution): Daiichi Sankyo; Advisory / Consultancy, Research grant / Funding (institution): Epizyme; Advisory / Consultancy: Immunedesign; Advisory / Consultancy: Maxivax; Advisory / Consultancy, Research grant / Funding (institution): Karyopharm;

Volume 30 | Supplement 5 | October 2019

doi:10.1093/annonc/mdz283 | v695

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S. Bauer1, J.H. Lewis2, H. Gelderblom3, M. van de Sande4, S. Stacchiotti5, J.H. Healey6, W.D. Tap7, A.J. Wagner8, A. Lopez Pousa9, M. Druta10, C-C. Lin11, H.A. Baba12, A. Yver13, D.E. Shuster14, J. McGill15, X. Gu16, L.D. DeLeve17 1 Medical Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany, 2Division of Gastroenterology, Georgetown University Hospital, Washington, DC, USA, 3Medical Oncology, Leiden University Medical Center, Leiden, Netherlands, 4 Orthopedic Surgery, Leiden University Medical Center, Leiden, Netherlands, 5Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, 6Orthopedic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA, 7Sarcoma Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA, 8 Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA, 9Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, 10Medical Oncology, Moffitt Cancer Center, Tampa, FL, USA, 11Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan, 12Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany, 13Oncology Research and Development, Daiichi Sankyo, Inc., Basking Ridge, NJ, USA, 14Clinical Development, Oncology, Daiichi Sankyo, Inc., Basking Ridge, NJ, USA, 15Clinical Safety and Pharmacovigilance, Daiichi Sankyo, Inc., Basking Ridge, NJ, USA, 16Biostatistics and Data Management, Daiichi Sankyo, Inc., Basking Ridge, NJ, USA, 17Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

abstracts

Annals of Oncology

Table: 1696P Frequency of Liver Test Abnormalities Clinical Parameter

Phase III ENLIVEN Crossover (800 mg/d)* n ¼ 30

Phase I PLX10801 TGCT Cohort (1000 mg/d)* n ¼ 39

Other Phase I† (600 or 800 mg/d)* n ¼ 10

Total‡N ¼ 140

Aminotransferase elevations, n (%) ALT or AST 1 to < 3  ULN 3 to < 5  ULN 5 to < 10  ULN 10 to < 20  ULN 20  ULN

48 (79) 8 (13) 7 (11) 3 (5) 2 (3)

21 (70) 3 (10) 2 (7) 1 (3) 0

27 (69) 4 (10) 2 (5) 2 (5) 0

6 (60) 2 (20) 0 0 0

102 (73) 17 (12) 11 (8) 6 (4) 2 (1)

Mixed or cholestatic hepatotoxicity, n (%) ALT or AST 3 , TBIL 2 , and ALP 2  ULN (Hy’s law) ALT or AST 3 , TBIL 2 , and ALP 2  ULN TBIL 2  ULN (in absence of ALT 3  or ALP >2  ULN)

0 3 (5) 0

0 0 0

0 1 (3)§ 1 (3)

0 1 (10) 0

0 5 (4)§ 1 (1)

*Pex starting dose. † Includes 1 TGCT pt receiving 600 mg/d in NCT02734433 and 9 TGCT pts receiving 800 mg/d in NCT03291288. ‡Mean Pex duration of all studies was 71 wk (range, 2.14-259.14). § Includes 1 TGCT pt with a single time-point elevation of TBIL considered unrelated to treatment. ALP ¼ alkaline phosphatase; ALT ¼ alanine aminotransferase; AST ¼ aspartate aminotransferase; TBIL ¼ total bilirubin; ULN ¼ upper limit of normal.

Research grant / Funding (institution): Advenchen; Research grant / Funding (institution): Novartis; Research grant / Funding (institution): Pfizer. J.H. Healey: Advisory / Consultancy: Stryker; Advisory / Consultancy: Daiichi Sankyo; Advisory / Consultancy: Agios; Research grant / Funding (self): Illuminoss. W.D. Tap: Shareholder / Stockholder / Stock options: Certis Oncology Solutions; Shareholder / Stockholder / Stock options: Atropos Therapeutics; Honoraria (self), Advisory / Consultancy: Eli Lilly; Honoraria (self), Advisory / Consultancy: EMD Serono; Honoraria (self), Advisory / Consultancy: Novartis; Honoraria (self), Advisory / Consultancy: Eisai; Honoraria (self), Advisory / Consultancy: Janssen; Honoraria (self), Advisory / Consultancy: Immune Design; Honoraria (self), Advisory / Consultancy: Adaptimmune; Honoraria (self), Advisory / Consultancy: Daiichi Sankyo; Honoraria (self), Advisory / Consultancy: Blueprint; Honoraria (self), Advisory / Consultancy: Loxo; Honoraria (self), Advisory / Consultancy: GlaxoSmithKline; Honoraria (self), Advisory / Consultancy: Agios Pharmaceuticals; Honoraria (self), Advisory / Consultancy: NannoCarrier; Advisory / Consultancy: Plexxikon Pharmaceuticals; Licensing / Royalties, Companion Diagnostic for CDK4 inhibitors: Companion Diagnostic for CDK4 inhibitors. A.J. Wagner: Honoraria (self): Novartis; Advisory / Consultancy, Research grant / Funding (institution): Daiichi Sankyo; Advisory / Consultancy, Research grant / Funding (institution): Eli Lilly; Advisory / Consultancy, Research grant / Funding (institution): Five Prime; Advisory / Consultancy: Nanosphere; Research grant / Funding (institution): Plexxikon; Research grant / Funding (institution): Karyopharm; Research grant / Funding (institution): Celldex; Research grant / Funding (institution): Aadi Bioscience. A. Lopez Pousa: Research grant / Funding (self): CEBIOTEX. M. Druta: Honoraria (self), Advisory / Consultancy, Travel / Accommodation / Expenses: Daiichi Sankyo; Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony: Eisai. C. Lin: Honoraria (self), Advisory / Consultancy: Novartis; Honoraria (self): Roche; Travel / Accommodation / Expenses: BeiGene; Research grant / Funding (institution): Daiichi Sankyo. A. Yver: Shareholder / Stockholder / Stock options, Full / Part-time employment: Daiichi Sankyo. D.E. Shuster: Shareholder / Stockholder / Stock options, Full / Part-time employment: Daiichi Sankyo; Shareholder / Stockholder / Stock options: Pfizer; Shareholder / Stockholder / Stock options: Bristol-Myers Squibb; Shareholder / Stockholder / Stock options: Merck; Shareholder / Stockholder / Stock options: Regeneron; Shareholder / Stockholder / Stock options: Exelixis. J. McGill: Advisory / Consultancy, Full / Part-time employment: Daiichi Sankyo. X. Gu: Shareholder / Stockholder / Stock options, Full / Part-time employment: Daiichi Sankyo; Shareholder / Stockholder / Stock options, Full / Part-time employment, Immediate family member: PTC Therapeutics. L.D. DeLeve: Honoraria (self): Pfizer; Honoraria (self): Boehringer Ingelheim; Advisory / Consultancy: Daiichi Sankyo; Advisory / Consultancy: AbbVie; Advisory / Consultancy: SeaGen; Licensing / Royalties, Univ and I have filed provisional patent: University of Southern California. All other authors have declared no conflicts of interest.

v696 | Sarcoma

Volume 30 | Supplement 5 | October 2019

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Phase III ENLIVEN Randomized (1000 mg/d)* n ¼ 61