Results of the TAPPAS trial: An adaptive enrichment Phase 3 trial of TRC105 and pazopanib (P) versus pazopanib alone in patients with advanced angi...

Date 30 September 2019
Event ESMO 2019 Congress
Session Proffered Paper - Sarcoma
Topics Soft Tissue Sarcomas
Presenter Robin Lewis Jones
Citation Annals of Oncology (2019) 30 (suppl_5): v683-v709. 10.1093/annonc/mdz283
Authors R.L. Jones1, V. Ravi2, A.S. Brohl3, S.P. Chawla4, K. GANJOO5, A. Italiano6, S. ATTIA7, M. BURGESS8, K. THORNTON9, L. CRANMER10, L. LIU11, C. Theuer12, R. MAKI13
  • 1Medical Oncology, Royal Marsden Hospital NHS Foundation Trust, SW3 6JJ - London/GB
  • 2Department Of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston/US
  • 3Department Of Cutaneous Oncology, H. Lee Moffitt Cancer Center, 33612 - Tampa/US
  • 4Oncology, Sarcoma Oncology Research Center, 90403 - Santa Monica/US
  • 5Medical Oncology, Stanford University, 94304 - STANFORD/US
  • 6Early Phase Trials Unit, Institute Bergonié, 33076 - Bordeaux/FR
  • 7Medical Oncology, MAYO CLINIC IN FLORIDA, 32224 - Jacksonville/US
  • 8Medical Oncology, University of Pittsburgh Medical Center, 15213 - PITTSBURGH/US
  • 9Sarcoma, Dana-Farber Cancer Institute, 02115 - BOSTON/US
  • 10Medicl Oncology, UNIVERSITY OF WASHINGTON, 98109 - SEATTLE/US
  • 11Clinical Trials Manager, TRACON Pharmaceuticals, 92122 - SAN DIEGO/US
  • 12Clinical Trials, Tracon Pharmaceuticals, Inc., 92122 - SAN DIEGO/US
  • 13Medical Oncology, Northwell Health/Cold Spring Harbor Laboratory, 11042 - LONG ISLAND/US

Abstract

Background

Pazopanib (P) is approved for refractory advanced STS refractory. A retrospective study of 40 AS patients treated with P, reported a median progression-free survival (PFS) of 3.1 months and median overall survival (OS) 9.9 months (Kollar et al, Acta Oncol, 2017). Endoglin is an essential angiogenic receptor expressed on AS cells that is upregulated following VEGF inhibition. TRC105, an endoglin antibody, combined with P produced a median PFS of 7.8 months in chemotherapy-refractory and P-naïve patients enrolled on a phase I-II trial.

Methods

TAPPAS was a randomized multicenter trial of TRC105/P vs P that enrolled cutaneous and non-cutaneous AS patients and incorporated an adaptive enrichment design. Key inclusion criteria: 0-2 prior lines of therapy, ECOG ≤ 1. The primary endpoint was PFS by RECIST 1.1 by independent radiographic review (+ cutaneous lesions by photography) (IRR). Secondary endpoints included PFS by investigator review (INV) and OS. An interim analysis to determine the final sample size was conducted following enrollment of 123 patients.

Results

Of 123 pts (TRC105/P, 62; P, 61), 60% were female, 89% were white; median age was 68 years (range: 24-82); 46% were ECOG PS 0; 50% had cutaneous disease; and 28% had no prior treatment. TRC105/P did not prolong median PFS or OS compared to P (Table). Most common all-grade adverse events (AEs) in TRC105/P vs P: fatigue (61% vs 55%); headache (64% vs 23%), diarrhea (57% vs 51%), nausea (48% vs 49%), vomiting (38% vs 23%), anemia (44% vs 9.4%), epistaxis (56% vs 3.8%) & hypertension (36% vs.55%).Table:

1667O

PTRC105/P
Median PFS, mo (95% CI), IRR4.3 (2.9-NE)4.2 (2.8-8.3)
HR (95% CI)0.98 (0.52-1.8)
p-value0.95
Median PFS, mo (95% CI), Investigator2.9 (2.6-4.1)3.9 (2.6-5.5)
HR (95% CI)0.77 (0.46-1.78)
p-value0.31
Median PFS, cutaneous, mo (95% CI), IRR5.6 (2.6-5.6)4.2 (2.8-8.3)
HR (95% CI)1.07 (0.43, 2.7)
p-value0.89
Overall Survival, mo (95% CI)8.7 (7.4, NE)NE (6.8, NE)
Odds ratio (95% CI)0.90 (0.46, 1.74)
p-value0.74
Overall Survival, cutaneous, mo (95% CI)8.0 (6.7, NE) NE (6.8, NE)
Odds ratio (95% CI)0.68 (0.25, 1.84)
p-value0.45

NE: not estimable; CI: confidence interval; mo: months

Conclusions

TRC105 did not demonstrate activity when combined with P in angiosarcoma. This was the 1st randomized phase III trial in angiosarcoma. These data provide a benchmark of the activity of P in 1st + 2nd-line setting in AS. A number of patients derived durable benefit from the combination schedule, indicating the heterogeneity of angiosarcomas.

Clinical trial identification

NCT 02979899.

Editorial acknowledgement

Legal entity responsible for the study

Tracon Pharmaceuticals, Inc.

Funding

Tracon Pharmaceuticals, Inc.

Disclosure

R.L. Jones: Advisory / Consultancy: Tracon; Advisory / Consultancy: Adaptimmune; Advisory / Consultancy: Blueprint; Advisory / Consultancy: Clinigen; Advisory / Consultancy: Deciphera; Advisory / Consultancy: Daichii; Advisory / Consultancy: Eisai; Advisory / Consultancy: Epizyme; Advisory / Consultancy: PharmaMar; Advisory / Consultancy: Lilly; Advisory / Consultancy: Merck. L. Liu: Full / Part-time employment: Tracon. C. Theuer: Full / Part-time employment: Tracon. All other authors have declared no conflicts of interest.