1240P - A phase 1b study of the anti-cancer stem cell agent demcizumab (DEM), pemetrexed (PEM) & carboplatin (CARBO) in pts with 1st line non-squamous NSCLC

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anti-Cancer Agents & Biologic Therapy
Non-Small-Cell Lung Cancer, Metastatic
Presenter Robert Stagg
Citation Annals of Oncology (2014) 25 (suppl_4): iv426-iv470. 10.1093/annonc/mdu349
Authors R. Stagg1, M. McKeage2, D. Kotasek3, B. Markman4, M. Hidalgo5, M. Millward6, M. Jameson7, D. Harris8, J. Dupont1, B. Hughes9
  • 1Clinical Research, OncoMed Pharmaceutical, 94063 - Redwood City/US
  • 2Auckland Cancer Center, University of Auckland, Auckland/NZ
  • 3Medical Oncology, Adelaide Cancer Centre, Adelaide/AU
  • 4Medial Oncology, Monash Health, Melbourne/AU
  • 5Ciocc, Hospital Madrid Norte San Chinarro Centro Integral Oncologico Clara Campal, ES-28029 - Madrid/ES
  • 6Medical Oncology, Sir Charles Gardner Hospital, Perth/AU
  • 7Medical Oncology, Waikato Hospital, Hamilton/NZ
  • 8Medical Oncology, Christchurch Hospital, Christchurch/NZ
  • 9Medical Oncology, Royal Brisbane & Women's Hospital, Brisbane/AU

Abstract

Aim

Delta-like ligand 4 (DLL4) activates the Notch pathway and is important for cancer stem cell (CSC) survival. DEM is a humanized IgG2 anti-DLL4 antibody that has been shown to inhibit tumor growth, decrease CSC frequency & cause dysfunctional sprouting of new vessels resulting in an antiangiogenic effect in human tumor xenograft models.

Methods

Pts received DEM (2.5 or 5 mg/kg), PEM 500 mg/m2 & CARBO (AUC = 6) every 3 wks X 6 cycles followed by maintenance DEM (cohorts 1-4) or truncated DEM (5 or 7.5 mg/kg), PEM 500 mg/m2 & CARBO (AUC = 6) every 3 wks X 4 cycles followed by maintenance PEM (cohorts 5 & 6). The objectives were to determine the MTD, safety, efficacy, immunogenicity, pharmacokinetics & biomarkers of Notch signaling.

Results

Thirty-nine pts were enrolled; 6 received 2.5 mg/kg, 20 received 5 mg/kg, 6 received 7.5 mg/kg of truncated DEM & 7 received 5 mg/kg of truncated DEM. Related AEs in > 20% of pts were: nausea (49%), fatigue (44%), hypertension (41%), vomiting (31%), edema (26%), neutropenia (26%), & increased B-type natriuretic peptide (BNP) (23%). Increased BNP values are an early indicator of the cardiac effects of DEM & mildly elevated values are being used to initiate cardioprotective therapy with an ACE inhibitor or carvedilol. Two pts receiving 5 mg/kg developed reversible pulmonary hypertension & heart failure on days 167 & 183, respectively. As a result, DEM treatment was limited to 63 days in cohorts 5 & 6. One of 32 (3%) evaluable pts had a RECIST CR, 13 (41%) had a PR and 14 had SD. The Kaplan Meier estimated median progression free survivals for the 2.5, 5, truncated 5 & truncated 7.5 mg/kg pts were 4.3, 5.3, not yet reached & 4.4 months, respectively. Five pts who discontinued the study for a reason other than progression (3 continued to receive CARBO & PEM off-study) were progression-free through Days 223 + , 243 + , 457 + , 497 + , 680+ and a sixth pt (who continued to receive CARBO & PEM off-study) progressed at Day 850.

Conclusions

This therapy was generally well tolerated with nausea, fatigue & hypertension being the most common drug related toxicities. Encouraging early clinical activity has been observed. Additional data with truncated DEM will be presented.

Disclosure

R. Stagg: I am an employee of OncoMed and I own stock in the company; J. Dupont: I work for OncoMed and own stock in the company. All other authors have declared no conflicts of interest.