Treatment with somatostatin analogues after radiopeptide therapy

Treatment with somatostatin analogues after radiopeptide therapy

Annals of Oncology In multivariate analysis for DFS, tumor size >25 mm and vascular invasion positivity, but not G2, were risk factors for recurrence...

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Annals of Oncology In multivariate analysis for DFS, tumor size >25 mm and vascular invasion positivity, but not G2, were risk factors for recurrence. The high-risk group with these factors had significantly worse 5- and 10-year disease-specific survivals (DSSs) compared to the low-risk group (100% and 100% vs. 90.9% and 68.2%, p ¼ 0.045). Conclusions: Revision of the Ki-67 LI cut-off for PanNENs G1/G2 based on WHO 2017 may be appropriate but G2 is not a risk factor for DFS. Tumor size >25 mm and vascular invasion positivity are potential risk factors. High-risk patients should be closely monitored during follow-up. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Treatment with somatostatin analogues after radiopeptide therapy

D. Handkiewicz Junak, A. Syguła, B. Jurecka-Lubieniecka, K. Hasse-Lazar, B. Jarzab Nucleare Medicine & Endocrine Oncology Department, Maria Sklodowska-Curie Institute - Oncology Center (MSCI), Gliwice Branch, Gliwice, Poland Background: Although neuroendocrine tumours (NET) constitute a very heterogeneous group, most of them express somatostatin receptors that enable treatment with somatostatin analogues, which proved to be effective both as bio- or radiopeptide therapy. However, little is now about combining these two treatment modalities. The aim of our prospective study was to evaluate the results of radiolabeled somatostatin analogues (PRRT) with or without "cold" somatostatin analogues (SA) as consolidation treatment. Methods: Patients with well-differentiated NET treated with PRRT (4 to 5 cycles repeated every 6 to 12 weeks) were included in the study. After the last cycle of PRRT response to radiopeptide treatment was evaluated with the scintigraphic, radiological and biochemical examination. Thereafter patients were randomly assigned either to treatment with SA or observation group (2:1 randomization). Initiation of the next line of therapy was left to the discretion of treating physician. Patients were followed-up at 4-12 months intervals with radiological examinations (CT or MRI) and receptors scintigraphy. The median time to progression was measured from the start of PRRT treatment till the day of disease progression confirmed in the radiological or scintigraphic examination. Results: 125 patients (79 in SA and 46 in the observation group) were included in the study. 81 patients were randomly assigned to somatostatin analogs and 44 to the observation group. The median follow-up the calculated from the start of PRRT was 54 months for the whole group of patients. During that time 85 (68%) progressed. There was a trend to longer progression-free survival in SSA group (47 vs 44 months), however, the difference was statistically insignificant. During observation period 32 patients died and there was no difference in time to death between both groups. In 9 patients after radiopeptide therapy chemotherapy was given. Chemotherapy was well tolerated and there were no late serious side effects. Conclusions: Preliminary results suggest that consolidation treatment with SA did not improve the results of PRRT. However, a larger number of patients and longer followup is necessary. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: D. Handkiewicz Junak: Travel / Accommodation / Expenses: Ipsen Novartis GenzymeSanofi. B. Jurecka-Lubieniecka: Travel / Accommodation / Expenses: Ipsen Novartis. B. Jarzab: Travel / Accommodation / Expenses: Ipsen Novartis Genzyme-Sanofi. All other authors have declared no conflicts of interest.

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Safety and tolerability of surufatinib in western patients with solid tumours

E. Hamilton1, J.S. Wang2, D. Li3, N.A. Dasari4, S. Paulson5, A.L. Cohn6, N.P. Sauter7, M. Kania7, J. Kauh7, G.S. Falchook8 1 Drug Development Unit, Sarah Cannon Research Institute-Cancer Centre, Nashville, TN, USA, 2Sarasota Cattlemen - Drug Development Unit, Sarah Cannon Research Institute, Sarasota, FL, USA, 3Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA, 4Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX, USA, 5Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, TX, USA, 6Medical Oncology, Rocky Mountain Cancer Centers, Denver, CO, USA, 7Clinical Development, Hutchison Medipharma (US), Inc., Florham Park, NJ, USA, 8Sarah Cannon Research Institute at HealthONE, Denver, CO, USA Background: Surufatinib, also called sulfatinib, is a targeted inhibitor of the tyrosine kinases VEGFR1, 2, and 3, FGFR1, and CSF1R. The safety profile of surufatinib was favorable in 2 completed studies (NCT 02133157 and 02267967) conducted in Chinese cancer patients (pts). Surufatinib has demonstrated anti-tumor activity in pts with advanced, well-differentiated neuroendocrine tumors (NETs) (response rate 17%) and is being evaluated in phase III trials. Methods: This is an ongoing dose escalation (ESC)/dose expansion (EXP) study being conducted in the United States to establish safety in Western pts. The ESC phase enrolled pts with any solid tumor. The EXP phase is enrolling pts with biliary tract

Volume 30 | Supplement 5 | October 2019

cancers, pancreatic NETs, or extrapancreatic NETs. The primary objective is to evaluate safety and tolerability and to determine the maximum-tolerated dose (MTD)/recommended phase II dose (RP2D). Results: As of the data cut-off date of 11 Feb 2019, 57 pts who enrolled and received  1 dose of surufatinib (35 in ESC, 22 in EXP), 23 were male, and median age was 62 years. The most common primary malignancies were bile duct (n ¼ 17), pancreatic NET (n ¼ 16), endometrial (n ¼ 3), and ovary (n ¼ 3). There were 6 pts in ESC with a DLT; 1/6 in the 100 mg QD (fatigue), 1/11 in the 300 mg QD (hypertension), and 4/13 in the 400 mg QD (2 proteinuria, 1 thrombocytopenia, and 1 ALT elevation) cohorts. The MTD/RP2D was 300 mg QD. The most frequent (20% incidence) treatment emergent adverse events (AEs) were diarrhea (35%), nausea (33%), fatigue (26%), hypertension (26%), and vomiting (21%). Grade  3 AEs were reported in 56% of pts; the most frequent ( 5% incidence) were hypertension (12%), diarrhea (5%), fatigue (5%), and proteinuria (5%). Fifteen pts had serious adverse events. Preliminary pharmacokinetic data (n ¼ 9) showed dose proportional increase in exposure and slightly higher (30%) exposure (AUC) compared to the Chinese pt population. Partial response was seen in 4 pts, with (by primary site, dose)1 endometrial, 100 mg QD; 1 bile duct, 300 mg QD; and 2 pancreatic NET, 300 mg QD. Conclusions: The safety profile of surufatinib at the RP2D in these Western cancer pts is consistent with those from completed studies performed in Chinese pts and consistent with VEGF targeted therapy. Preliminary data show promising efficacy. Clinical trial identification: NCT02549937. Editorial acknowledgement: Hoang-Lan Nguyen, PhD, Hutchison MediPharma (US), Inc. Legal entity responsible for the study: Hutchison MediPharma, Limited. Funding: Hutchison MediPharma, Limited. Disclosure: E. Hamilton: Advisory / Consultancy, Research grant / Funding (institution): Eli Lilly; Advisory / Consultancy, Research grant / Funding (institution): Pfizer; Speaker Bureau / Expert testimony, Research grant / Funding (self): Genentech/Roche; Advisory / Consultancy: Flatiron Health; Advisory / Consultancy, Research grant / Funding (institution): Cascadian Therapeutics; Research grant / Funding (institution): Hutchison Medipharma; Research grant / Funding (institution): Oncomed; Research grant / Funding (institution): MedImmune; Research grant / Funding (institution): StemCentrx; Research grant / Funding (institution): AbbVie; Research grant / Funding (institution): Curis; Research grant / Funding (institution): Verastem; Research grant / Funding (institution): Zymeworks; Research grant / Funding (institution): Syndax; Research grant / Funding (institution): Lycera; Research grant / Funding (institution): Rgenix; Research grant / Funding (institution): Novartis; Research grant / Funding (institution): Mersana; Research grant / Funding (institution): TapImmune; Research grant / Funding (institution): BerGenBio; Research grant / Funding (institution): Tesaro; Research grant / Funding (institution): Medivation; Research grant / Funding (institution): Kadmon; Research grant / Funding (institution): Boehringer Ingelheim; Research grant / Funding (institution): Eisai; Research grant / Funding (institution): H3 Biomedicine; Research grant / Funding (institution): Radius Health; Research grant / Funding (institution): Acerta; Research grant / Funding (institution): Takeda; Research grant / Funding (institution): MacroGenics; Research grant / Funding (institution): Immunomedics; Research grant / Funding (institution): FujiFilm; Research grant / Funding (institution): eFFECTOR. J.S. Wang: Speaker Bureau / Expert testimony: AstraZeneca. D. Li: Advisory / Consultancy, Speaker Bureau / Expert testimony: Lexicon; Advisory / Consultancy: Novartis; Advisory / Consultancy, Speaker Bureau / Expert testimony: Ipsen; Advisory / Consultancy, Speaker Bureau / Expert testimony: Exelixis; Advisory / Consultancy: Bayer; Speaker Bureau / Expert testimony: Advanced Accelerator Applications; Research grant / Funding (institution): Brooklyn ImmunoTherapeutics. N.A. Dasari: Advisory / Consultancy: Lexicon; Advisory / Consultancy, Research grant / Funding (self): Novartis; Advisory / Consultancy: Ipsen; Advisory / Consultancy: Crinetics; Research grant / Funding (self): Merck; Research grant / Funding (self): Hutchison MediPharma; Research grant / Funding (self): eFFECTOR; Research grant / Funding (self): Eisai. S. Paulson: Advisory / Consultancy: AAA; Advisory / Consultancy, Research grant / Funding (institution): Taiho; Advisory / Consultancy: Ipsen; Advisory / Consultancy, Research grant / Funding (institution): Bristol-Myers Squibb; Advisory / Consultancy: Eisai; Advisory / Consultancy: Amgen; Shareholder / Stockholder / Stock options: Aptose; Shareholder / Stockholder / Stock options: Seattle Genetics; Shareholder / Stockholder / Stock options: Immunomedics; Research grant / Funding (institution): Incyte; Research grant / Funding (institution): Exelixis. A.L. Cohn: Speaker Bureau / Expert testimony: Ipsen; Speaker Bureau / Expert testimony: Bristol-Myers Squibb. N.P. Sauter: Shareholder / Stockholder / Stock options, Full / Part-time employment: Hutchison MediPharma Ltd. M. Kania: Shareholder / Stockholder / Stock options, Full / Part-time employment: Hutchison MediPharma Ltd. J. Kauh: Shareholder / Stockholder / Stock options, Full / Part-time employment: Hutchison MediPharma Ltd. G.S. Falchook: Licensing / Royalties: Wolters Kluwer; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Fujifilm; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: EMD Serono; Travel / Accommodation / Expenses: Bristol-Myers Squibb; Research grant / Funding (institution), Travel / Accommodation / Expenses: Millenium; Speaker Bureau / Expert testimony: Total Health Conferencing; Research grant / Funding (institution): 3-V Biosciends; Research grant / Funding (institution): AbbVie; Research grant / Funding (institution): ADC Therapeutics; Research grant / Funding (institution): Aileron; Research grant / Funding (institution): ASCO; Research grant / Funding (institution): Amgen; Research grant / Funding (institution): ARMO; Research grant / Funding (institution): AstraZeneca; Research grant / Funding (institution): Beigene; Research grant / Funding (institution): Bioatla; Research grant / Funding (institution): Biothera; Research grant / Funding (institution): Celldex; Research grant / Funding (institution): Celgene; Research grant / Funding (institution): Ciclomed; Research grant / Funding (institution): Curegenix; Research grant / Funding (institution): Curis DelMar; Research grant / Funding (institution): eFFECTOR; Research grant / Funding (institution): Eli Lilly; Research grant / Funding (institution): Exelixis; Research grant / Funding (institution): Genmab; Research grant / Funding (institution): GlaxoSmithKline; Research grant / Funding (institution): Hutchison MediPharma Ltd; Research grant / Funding (institution): Ignyta; Research grant / Funding (institution): Incyte; Research grant / Funding (institution): Jacobio; Research grant / Funding (institution): Jounce; Research grant / Funding (institution): Koltan; Research grant / Funding (institution): MedImmune; Research grant / Funding (institution): Merck; Research grant / Funding (institution): miRNA Therapeutics; Research grant / Funding (institution): Nationals Institutes of Health; Research grant / Funding (institution): Novartis; Research grant / Funding (institution): Oncomed; Research grant / Funding (institution): Oncothyreon; Research grant / Funding (institution): Precision Oncology; Research grant / Funding (institution): Regeneron; Research grant / Funding (institution): Rgenix; Research grant / Funding (institution): Strategia; Research grant / Funding (institution): Syndax; Research grant / Funding (institution): Taiho; Research grant / Funding (institution): Takeda; Research grant / Funding (institution): Tarveda;

doi:10.1093/annonc/mdz256 | v569

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