1079P - Long-term response to second-line afatinib in patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC): analysis of...

Date 10 September 2017
Event ESMO 2017 Congress
Session Poster display session
Topics Anti-Cancer Agents & Biologic Therapy
Cancer in Adolescents
Head and Neck Cancers
Presenter Jean-Pascal Machiels
Citation Annals of Oncology (2017) 28 (suppl_5): v372-v394. 10.1093/annonc/mdx374
Authors J. Machiels1, G. de Castro Jr2, L. de Souza Viana3, R. Galiulin4, M. Tahara5, U.R. Nicolau6, C. Le Tourneau7, K. Okami8, V. Vladimirov9, A. Izmailov10, K. Hoermann11, L. Licitra12, R. Haddad13, E.E. Cohen14, N. Dupuis15, J. Love16, E. Zografos17, E. Ehrnrooth18, J. Fayette19
  • 1Institut Roi Albert Ii, Service D’oncologie Médicale, Cliniques Universitaires Saint-luc And Institut De Recherche Clinique Et Expérimentale (pole Miro), Université Catholique de Louvain, 00 - Brussels/BE
  • 2Department Of Clinical Oncology, Instituto do Câncer do Estado, São Paulo/BR
  • 3Department Of Medical Oncology, Hospital de Câncer de Barretos, São Paulo/BR
  • 4Chemotherapy Department, Omsk Regional Oncology Center, Omsk/RU
  • 5Division Of Head And Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa/JP
  • 6Departamento De Oncologia, Hospital A.C. Camargo, São Paulo/BR
  • 7Department Of Medical Oncology, Institut Curie, Paris/FR
  • 8Department Of Otolaryngology, Tokai University, Isehara/JP
  • 9Policlinic, Pyatigorsk Oncological Dispensary, Pyatigorsk/RU
  • 10Department Of Oncology, Bashkirin State Medical University, Ufa/RU
  • 11Department Of Otolaryngology, Head And Neck Surgery, University Hospital Mannheim, Mannheim/DE
  • 12Fondazione Irccs Istituto Nazionale Tumori, Milan, It, and University of Milan, Milan/IT
  • 13Department Of Medical Oncology, Dana-farber Cancer Institute, Harvard Medical School and Department of Medicine, Brigham and Women’s Hospital, Boston/US
  • 14San Diego Moores Cancer Center, University of California, La Jolla/US
  • 15Development, Biodesix Inc., Boulder/US
  • 16Oncology Statistics, Boehringer Ingelheim Corporation, Ridgefield/US
  • 17N/a, Boehringer Ingelheim, Bracknell/GB
  • 18Ta Oncology, Boehringer Ingelheim, Danmark A/S, Copenhagen/DK
  • 19Léon Bérard Center And Hospices Civils De Lyon, University of Lyon, 69008 - Lyon/FR

Abstract

Background

In the Phase III LHN1 trial, second-line afatinib (A) significantly improved PFS (primary endpoint) vs methotrexate (MTX) in pts with R/M HNSCC. Tumour biomarker analyses have shown that survival benefit with A vs MTX was more pronounced in pts with p16/ErbB3-negative, EGFR-amplified, PTEN-positive disease. We present post-hoc analyses of A long-term responders (LTRs).

Methods

Pts with incurable R/M HNSCC who had received first-line platinum-based therapy were randomised to A (40mg/day) or MTX (40mg/m2/week) and treated until progression/intolerable AE. LTRs were defined as pts treated with A ≥ 12 mos. Tumour biomarkers were assessed by IHC (p16, ErbB3, PTEN, cMET) and FISH (EGFR amplification); pre-treatment (tx) serum samples were analysed with the VeriStrat® (VS) test and classified as VS-Good/Poor.

Results

11/322 (3%) pts treated with A were LTRs with a median (range) tx-duration of 16 (12–39) mos. All pts had stopped tx at analysis. Baseline characteristics in LTRs were similar to the overall dataset, except (LTRs/overall): oral cavity primary tumour site (45%/29%); M1 disease (45%/66%); previous therapy with EGFR-antibodies (18%/59%). Median OS was 18.1 mos; median PFS (central independent review) was 14.9 mos. ORR was 45% (CR: 18%; n = 2). The frequency of pts who received ≥1 subsequent therapy was similar to the overall dataset (LTRs, 45%; overall, 51%). In LTRs with available biomarker data, 3/3 (100%) pts were p16-negative, 4/4 (100%) pts were ErbB3-negative, 2/4 (50%) pts were PTEN-positive, 3/3 (100%) pts were cMET-positive, 2/3 (67%) pts had EGFR-amplification, and 5/5 (100%) pts were VS-Good. Tolerability-guided dose reductions were more frequent among LTRs (55% vs 32% overall).

Conclusions

In the LHN1 study, some platinum-pre-treated pts with R/M HNSCC derived a long-term survival benefit from A; median OS was ∼1.5 yrs and >11 mos longer than in the overall dataset. Limited biomarker data available in these LTRs suggests that p16/ErbB3-negativity and EGFR-amplification might be potential predictive biomarkers for long-term benefit from A; however, results were not conclusive due to small sample size.

Clinical trial identification

NCT01345682

Legal entity responsible for the study

Boehringer Ingelheim

Funding

Boehringer Ingelheim

Disclosure

J-P. Machiels: Reports taking part in advisory boards for Debio, Innate, Nanobiotix, MSD, AstraZeneca, and grants from Janssen, Bayer, and Novartis outside the submitted work. K. Okami: Honoraria: Merck Serono Co., Ltd C. Le Tourneau: Advisory board: MSD, Amgen, BMS. Honoraria: MSD, BMS, Merck Serono, Novartis. E. Zografos: Employment Boehringer Ingelheim L. de Souza Viana: Research funding from Boehringer Ingelheim. L. Licitra: Participated in advisory boards for Eisai, Bristol-Myers Squibb, GlaxoSmithKline, Lilly, Merck Serono, Amgen, Boehringer Ingelheim, Debiopharm, VentiRX, SOBI, Novartis, AstraZeneca and Bayer. E. Cohen: Participated in a consulting or advisory role for AstraZeneca, Bayer, Bristol-Myers Squibb, Eisai, Merck, and Novartis, and has participated in speakers’ bureaus for Bayer and Eisai. N. Dupuis: Owns stock in Biodesix. J. Love, E. Ehrnrooth: Employee of Boehringer Ingelheim. J. Fayette: Received honoraria from Bristol-Myers Squibb and AstraZeneca. R. Galiulin, M. Tahara, K. Hoermann: COI to follow All other authors have declared no conflicts of interest.