1142P - Prognostic subgroups and impact of treatment for post-progression overall survival (ppOS) in patients (pts) with BRAFV600-mutated metastatic melano...

Date 09 October 2016
Event ESMO 2016 Congress
Session Poster display
Topics Anti-Cancer Agents & Biologic Therapy
Melanoma and other Skin Tumours
Presenter Paolo Ascierto
Citation Annals of Oncology (2016) 27 (6): 379-400. 10.1093/annonc/mdw379
Authors P.A. Ascierto1, A. Ribas2, J. Larkin3, G.A. McArthur4, K.D. Lewis5, A. Hauschild6, K.T. Flaherty7, E. McKenna8, Q. Zhu8, Y. Mun8, B. Dréno9
  • 1Melanoma, Cancer Immunotherapy And Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione Pascale, 80131 - Naples/IT
  • 2Medicine, Hematology & Oncology, Jonsson Comprehensive Cancer Center at the University of California, Los Angeles, Los Angeles/US
  • 3Medicine, Royal Marsden Hospital NHS Foundation Trust, London/GB
  • 4Oncology, Peter McCallum Cancer Centre, East Melbourne/AU
  • 5Oncology, University of Colorado Comprehensive Cancer Center, Aurora/US
  • 6Department Of Dermatology, University Hospital Schleswig-Holstein, 24105 - Kiel/DE
  • 7Medicine, Massachusetts General Hospital, Boston/US
  • 8Medical Affairs, Genentech, Inc., South San Francisco/US
  • 9Dermato Cancerology, Nantes University, Nantes/FR

Abstract

Background

A pooled analysis of pts treated with DTIC, VEM, or COBI + VEM in the BRIM-2, BRIM-3, BRIM-7, and coBRIM studies was performed to identify pt subgroups prognostic for ppOS, defined as time from progression (PD) to death from any cause. The impact of post-progression treatment (ppRx) on ppOS was also assessed.

Methods

All eligible pts with PD were included. Recursive partitioning for censored response variable in a conditional inference framework was performed to model relationships between prespecified covariates (at baseline or PD, initial treatment, and ppRx) and ppOS. Identified subgroups were applied to pooled treatment cohorts (DTIC, VEM, or COBI + VEM). ppRx was defined as ≥1 dose of immunotherapy (IT), targeted therapy (TT), or other (including IT + TT or no treatment) within 90 days after PD.

Results

In a pooled analysis of all pts (N = 809), baseline lactate dehydrogenase (LDH) level (normal, elevated ≤2× upper limit of normal [ULN], or >2× ULN), Eastern Cooperative Oncology Group performance status (ECOG PS) at PD (0 vs >0), baseline disease stage (IIIC/M1a/M1b vs M1c), and ppRx (IT/TT vs other) were significant prognostic factors for ppOS, producing 7 pt subgroups. Among all pts, 169 received IT (ipilimumab in 96%), 32 received TT, and 608 received other ppRx. After adjusting for other covariates (including initial treatment), ppRx with IT/TT was associated with longer ppOS. Pooled data for all pts, VEM and DTIC cohorts are in the Table. ppOS data for the COBI + VEM cohort were immature, but followed a similar pattern.

ppOS: Pooled Analysis of All pts and VEM and DTIC Cohorts

Prognostic Subgroup All pts VEM Cohort DTIC Cohort
N (events) ppOS, median, mo (95% CI) 3-year ppOS, % (95% CI) N (events) ppOS, median, mo (95% CI) 3-year ppOS, % (95% CI) N (events) ppOS, median, mo (95% CI) 3-year ppOS, % (95% CI)
Normal LDH + stage IIIC/M1a/M1b 196 (127) 11.8 (9.7-15.1) 22.2 (16.0-30.8) 108 (66) 11.2 (9.4-15.6) 22.3 (13.9-36.0) 58 (45) 13.0 (9.1-21.5) 24.6 (15.6-38.8)
Normal LDH + stage M1c + ppRx IT/TT 64 (46) 11.8 (9.9-16.1) 22.4 (13.4-37.7) 35 (25) 12.5 (10.4-19.9) 21.3 (10.3-44.1) 18 (18) 12.3 (9.7-NE) 25.9 (11.5-58.3)
Normal LDH + stage M1c + ppRx other + ECOG PS at PD 0 84 (67) 7.5 (5.8-12.2) 4.9 (1.4-17.4) 50 (42) 7.5 (5.2-13.2) 3.9 (0.6-24.0) 14 (13) 7.2 (5.8-17.7) 7.1 (1.1-47.2)
Normal LDH + stage M1c + ppRx other + ECOG PS at PD >0 71 (66) 3.6 (3.0-5.5) 1.8 (0.3-12.4) 41 (37) 4.6 (3.2-7.0) 3.9 (0.6-24.3) 19 (19) 3.4 (2.2-15.7) NE (NE-NE)
Elevated LDH (≤2× ULN) + ppRx IT/TT 64 (50) 7.9 (6.7-12.5) 7.8 (2.4-24.9) 37 (29) 8.9 (6.7-16.0) NE (NE-NE) 14 (12) 6.6 (4.9-NE) 14.3 (4.0-51.5)
Elevated LDH (≤2× ULN) + ppRx other 188 (161) 4.5 (3.7-5.2) NE (NE-NE) 99 (82) 3.7 (2.9-5.0) NE (NE-NE) 47 (46) 4.7 (3.8-6.6) NE (NE-NE)
Elevated LDH (>2× ULN) 142 (131) 2.3 (1.9-2.9) 4.5 (2.0-10.1) 89 (84) 2.4 (1.9-3.3) 3.9 (1.3-11.4) 25 (23) 2.4 (1.3-7.5) NE (NE-NE)

Abbreviations: CI, confidence interval; NE, not estimable.

Conclusions

A combination of LDH, disease stage at baseline, ppRx, and ECOG PS at PD identified 7 pt subgroups prognostic for ppOS. After adjusting for other covariates, ppRx was associated with ppOS, with similar results in DTIC and VEM cohorts.

Clinical trial identification

Legal entity responsible for the study

F. Hoffman-La Roche, Ltd.

Funding

F. Hoffman-La Roche, Ltd.

Disclosure

P.A. Ascierto: Consultant Or Advisory Role: BMS, Roche/Genentech, MSD, Ventana, Novartis, Amgen, and Array); Research funding (institution): BMS, Roche/Genentech, and Ventana. A. Ribas: Stock or Other Ownership: Compugen, CytomX, Five Prime, and Kite Pharma; Consulting or Advisory Role: Pfizer, Merck, Amgen, and Roche. J. Larkin: Institutional research support from MSD, BMS, Pfizer, and Novartis and nonremunerated consultancy for GSK, Novartis, MSD, BMS, Pfizer, and Roche/Genentech. G.A. McArthur: Consulting or Advisory Role: Provectus; Research Funding: Pfizer, Celgene, and Ventana; Travel, Accommodations, Expenses: Roche and Novartis. K.D. Lewis: Honoraria and Advisory Board: Roche/Genentech. A. Hauschild: Consulting or Advisory Role, Honoraria, and Travel Grants: Amgen, BMS, Celgene, Eisai, GSK, MedImmune, MelaSciences, Merck Serono, MSD/Merck, Novartis, Oncosec, and Roche Pharma. K.T. Flaherty: Consultant, honoraria: Roche/Genentech. E. McKenna, Y. Mun: Employment and stock or other ownership: Genentech/Roche. Q. Zhu: Employment: Genentech/Roche. B. Dréno: Consulting or advisory role: BMS, GSK, Roche, Novartis; speakers' bureau: BMS, GSK, Roche; research funding: BMS, GSK; travel, accommodations, expenses: BMS, Roche.