Efficacy and safety of ceritinib in ALK-positive non-small cell lung cancer (NSCLC) patients with leptomeningeal metastases (LM): Results from the...

Date 27 September 2019
Event ESMO 2019 Congress
Session Proffered Paper – CNS tumours
Topics Biological Therapy
Non-Small Cell Lung Cancer
Central Nervous System Malignancies
Cancer Treatment in Patients with Comorbidities
Thoracic Malignancies
Presenter Fabrice Barlesi
Citation Annals of Oncology (2019) 30 (suppl_5): v143-v158. 10.1093/annonc/mdz243
Authors F. Barlesi1, D. Kim2, E.M. Bertino3, M.J. van den Bent4, H. Wakelee5, P.Y. Wen6, P. Garrido Lopez7, S. Orlov8, M. Majem9, M. McKeage10, C. Yu11, F.K. Hurtado12, P. Cazorla Arratia13, Y. Song14, F. Branle15, M. Shi16, L.Q. Chow17
  • 1Department Of Multidisciplinary Oncology And Therapeutic Innovations, Aix Marseille University, CNRS, INSERM, CRCM, APHM, CEDEX 20 - Marseille/FR
  • 2Department Of Internal Medicine, Seoul National University Hospital, 03080 - Seoul/KR
  • 3Department Of Internal Medicine - Medical Oncology, The Ohio State University Comprehensive Cancer Centre, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, 43210 - Columbus/US
  • 4Brain Tûmor Center, Erasmus MC Daniel den Hoed Cancer Center, 3015GD - Rotterdam/NL
  • 5Department Of Medicine-oncology, Stanford University, 94305 - Stanford/US
  • 6Department Of Medical Oncology, Dana-Farber Cancer Institute, 02215 - Boston/US
  • 7Department Of Medical Oncology, Hospital Ramón Y Cajal, 28034 - Madrid/ES
  • 8Department Of Oncology, State Pavlov Medical University, 197022 - Saint-Petersburg/RU
  • 9Department Of Medical Oncology, Hospital de La Santa Creu I Sant Pau, 08025 - Barcelona/ES
  • 10Pharmacology And Clinical Pharmacology, And Auckland Cancer Society Research Centre, University of Auckland, 1142 - Auckland/NZ
  • 11Department Of Internal Medicine, National Taiwan University Hospital, 10002 - Taipei/TW
  • 12Department Of Translational Medicine, Novartis Institutes for Biomedical Research, 07936 - East Hanover/US
  • 13Department Of Clinical Development, Novartis Pharmaceuticals Corporation, 07936 - East hanover/US
  • 14Department Of Clinical Development, Novartis Pharmaceuticals Corporation, 07936 - East Hanover/US
  • 15Department Of Global Drug Development, Novartis AG, 4055 - Basel/CH
  • 16Department Of Clinical Development, Novartis Pharmaceuticals Corporation, 079363 - East Hanover/US
  • 17Department Of Oncology, University of Washington, 98109-4405 - Seattle/US

Abstract

Background

LM are seen in approximately 5% of ALK+ NSCLC patients (pts), and are associated with poor prognosis with standard treatment. Ceritinib is highly active in ALK+ NSCLC pts with previously reported intracranial/central nervous system activity. We report the efficacy and safety of ceritinib in ALK+ NSCLC pts with LM enrolled in the ASCEND-7 study (NCT02336451).

Methods

Pts with documented ALK + (FISH) NSCLC, CSF invasiveness with radiologically or cytologically confirmed LM, and ≥1 extracranial measurable lesion using RECIST v1.1 were eligible. The study objectives included evaluation of antitumor activity based on overall response rate (ORR), disease control rate (DCR), and progression-free survival (PFS). Data cut-off was Feb 6, 2019.

Results

Of the 18 LM pts enrolled, 14 pts (77.8%) also had brain metastases and 8 pts (44.4%) had measurable brain metastases at baseline. Majority of the pts (n = 16, 88.9%) had received prior crizotinib and 7 pts (38.9%) had received prior brain radiotherapy. Median duration of exposure to ceritinib was 18.1 weeks (range: 1.7–125.9). Whole body ORR by investigator assessment was 16.7% (95% CI: 3.6, 41.4) with median duration of response of 5.5 months (95% CI: 3.7, 9.9) and a clinically significant median PFS of 5.2 months (95% CI: 1.6, 7.2). Median duration of follow-up for PFS was 3.84 months (range: 0.5–13). Additional efficacy endpoints are included in the below Table. Adverse events (AEs, all grades, regardless of study drug relationship) were reported in all 18 pts. Grade 3/4 AEs occurring in ≥ 10% of pts were increased alanine aminotransferase (22.2%), hyperglycemia (16.7%), increased gammaglutamyltransferase (11.1%), pneumonia (11.1%), and increased lipase (11.1%). Table: Efficacy resultsTable: 390O

Endpoint per investigator assessmentArm 5 (ALK+ NSCLC pts with LM) N = 18
Whole body Response (RECIST v1.1)
ORR, % (95% CI)16.7 (3.6, 41.4)
DCR, % (95% CI)66.7 (41.0, 86.7)
Median DOR, (months) [95% CI]5.5 (3.7, 9.9)
Median PFS, (months) [95% CI]5.2 (1.6, 7.2)
Intracranial response* (modified RECIST v1.1)M = 8
ORR, % (95% CI)12.5 (0.3, 52.7)
DCR, % (95% CI)62.5 (24.5, 91.5)
Extracranial response (RECIST v1.1)
ORR, % (95% CI)22.2 (6.4, 47.6)
DCR, % (95% CI)72.2 (46.5, 90.3)
Median OS, months (95% CI)7.2 (1.6, 16.9)
*

In patients with measurable brain metastases M, number of patients with measurable brain metastases at baseline DCR, disease control rate; DOR, duration of response; NE, not estimable; ORR, overall response rate; OS, overall survival; PFS, progression free survival; RECIST, Response Evaluation Criteria in Solid Tumors.

Conclusions

Ceritinib demonstrated a clinically meaningful efficacy and a safety profile similar to earlier reported results in this largest reported set of ALK+ NSCLC pts with LM.

Clinical trial identification

NCT02336451.

Editorial acknowledgement

Aarti Kamaraj, Novartis Healthcare Pvt Ltd (Hyderabad, India).

Legal entity responsible for the study

Novartis Pharmaceuticals.

Funding

Novartis Pharmaceuticals.

Disclosure

F. Barlesi: Honoraria (self): AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer–Ingelheim, Eli Lilly Oncology; Honoraria (self): F. Hoffmann–La Roche Ltd, Novartis, Merck, MSD, Pierre Fabre, Pfizer and Takeda; Research grant / Funding (institution): Abbvie, ACEA, Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer–Ingelheim, Eisai, Eli Lilly Oncology, F. Hoffmann–La Roche Ltd, Genentech, Ipsen, Ignyta, Innate Pharma, Loxo, Novartis, Medimmune, Merck, MSD, Pierre Fabre, Pfizer, Sanofi-Aventis; Non-remunerated activity/ies, Principal investigator: AstraZeneca, BMS, Merck, Pierre Fabre and F. Hoffmann-La Roche, Ltd, sponsored trials (or ISR); Research grant / Funding (institution): Takeda. D. Kim: Research grant / Funding (institution): Alpha Biopharma, AstraZeneca/Medimmune, Hanmi, Janssen, Merus, Mirati Therapeutics, MSD, Novartis, ONO Pharmaceutical, Pfizer, Roche/Genentech, Takeda, TP Therapeutics, Xcovery, and Yuhan. E.M. Bertino: Advisory / Consultancy: Takeda; Speaker Bureau / Expert testimony: Pfizer. M.J. van den Bent: Honoraria (self): Celgene, Agios, Boehringer, BMS, Abbvie; Research grant / Funding (institution): Abbvie. H. Wakelee: Honoraria (self): Novartis, AZ; Advisory / Consultancy, Compensated: AstraZeneca, Xcovery, Janssen; Advisory / Consultancy, Not compensated: Merck, Takeda, Genentech/Roche; Research grant / Funding (institution): ACEA Biosciences, Arrys Therapeutics, AstraZeneca/Medimmune, Bayer (under Suki and not me), BMS, Celgene, Clovis Oncology, Exelixis,, Genentech/Roche, Gilead, Lilly, Merck, Novartis, Pfizer, Pharmacyclics, Xcovery; Travel / Accommodation / Expenses: AstraZeneca; Officer / Board of Directors: International Association for the Study of Lung Cancer (IASLC). P.Y. Wen: Advisory / Consultancy: Agios, AstraZeneca, Beigene, Eli Lily, Genentech/Roche, Karyopharm, Kazia, MediciNova, Merck, Novartis, Oncoceutics, Sanofi-Aventis, VBI Vaccines, Tocagen; Speaker Bureau / Expert testimony: Merck, Prime Oncology; Research grant / Funding (institution): Agios, AstraZeneca, Beigene, Eli Lily, Genentech/Roche, Karyopharm, Kazia, MediciNova, Merck, Novartis, Oncoceutics, Sanofi-Aventis, VBI Vaccines. P. Garrido Lopez: Advisory / Consultancy: Roche, MSD, BMS, Boerhinger Ingelheim, Pfizer, Abbvie, Guardant Health, Novartis, Lilly, AstraZeneca, Jansen, Sysmex, Blueprint Medicines, Takeda; Speaker Bureau / Expert testimony: Roche, MSD, BMS, Pfizer, Novartis, Boerhinger Ingelheim, Rovi; Research grant / Funding (institution), Financial support for clinical trials: Roche, MSD, BMS, Takeda, Lilly, Pfizer, Novartis, Pharmamar, Celgene, Sanofi, GSK, Theradex Oncology, BluePrint Medicines; Research grant / Funding (institution), Financial support for contracted research: Guardant Health, Sysmex. M. Majem: Advisory / Consultancy: Roche, MSD, AstraZeneca, Boehringer, Tesaro, Takeda, Pierre Fabre; Speaker Bureau / Expert testimony: Roche, BMS, MSD, AstraZeneca, Boehringer, Hellsin, Pierre Fabre, Amgen; Research grant / Funding (self): BMS; Travel / Accommodation / Expenses: BMS, MSD, AstraZeneca, Lilly. M. McKeage: Advisory / Consultancy: Novartis, Pfizer; Research grant / Funding (institution): Novartis, Pfizer, Roche. C. Yu: Honoraria (self): Roche, AstraZeneca, Ono pharma, Boehringer-Ingelheim; Advisory / Consultancy: Roche, AstraZeneca, Ono pharma, Boehringer-Ingelheim. F.K. Hurtado: Shareholder / Stockholder / Stock options: Novartis Pharmaceuticals Corp.; Full / Part-time employment: Novartis Pharmaceuticals Corp. P. Cazorla Arratia: Shareholder / Stockholder / Stock options: Novartis Pharmaceuticals Corporation; Full / Part-time employment: Novartis Pharmaceuticals Corporation. Y. Song: Shareholder / Stockholder / Stock options, Restricted Stock Unit: Novartis Pharmaceutical Corporation; Full / Part-time employment: Novartis Pharmaceutical Corporation. F. Branle: Shareholder / Stockholder / Stock options: Novartis AG; Full / Part-time employment: Novartis AG. M. Shi: Shareholder / Stockholder / Stock options: Novartis; Full / Part-time employment: Novartis Pharmaceuticals Corporation. L.Q. Chow: Advisory / Consultancy: Bristol-Myers Squibb, Merck, Genentech, AstraZeneca/Medimmune, Pfizer, Seattle Genetics, Novartis, Dynavax Inc., Alkermes, Amgen, Sanofi-Genzyme, Takeda; Research grant / Funding (institution): Bristol-Myers Squibb, Merck, Genentech, AstraZeneca/Medimmune, Pfizer, Seattle Genetics, Novartis, Dynavax Inc. and Alkermes,Incyte, VentiRx and Lily/Imclone. All other authors have declared no conflicts of interest.