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CNS tumours

2870 - REGOMA: a randomized, multicenter, controlled open-label phase II clinical trial evaluating regorafenib activity in relapsed glioblastoma patients

Date

08 Sep 2017

Session

CNS tumours

Topics

Cytotoxic Therapy;  Prostate Cancer;  Central Nervous System Malignancies

Presenters

Giuseppe Lombardi

Citation

Annals of Oncology (2017) 28 (suppl_5): v605-v649. 10.1093/annonc/mdx440

Authors

G. Lombardi1, G.L. De Salvo2, A.A. Brandes3, M. Eoli4, R. Rudà5, M. Faedi6, I. Lolli7, A. Pace8, S. Rizzato9, D. Germano10, F. Pasqualetti11, M. Farina2, G. Magni2, A. Pambuku1, E. Bergo1, G. Cabrini12, S. Indraccolo13, M.P. Gardiman14, V. Zagonel1

Author affiliations

  • 1 Department Of Clinical And Experimental Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, 35128 - Padova/IT
  • 2 Clinical Trials And Biostatistics Unit, Veneto Institute of Oncology IOV-IRCCS, Padova/IT
  • 3 Medical Oncology Department, Azienda USL-IRCCS Scienze Neurologiche, Bologna/IT
  • 4 Molecular Neuroncology Unit, Carlo Besta Institute, Milano/IT
  • 5 Department Of Neuro-oncology, University of Turin and City of Health and Science Hospital, Torino/IT
  • 6 Medical Oncology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) - IRCCS, Meldola/IT
  • 7 Medical Oncology Unit, IRCCS-"Saverio de Bellis", Castellana Grotte/IT
  • 8 Neuroncology Unit, Istituto Nazionale Tumori Regina Elena, Roma/IT
  • 9 Medical Oncology Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine/IT
  • 10 Medical Oncology Unit, Azienda Ospedaliera "G. Rummo", Benevento/IT
  • 11 Radiotherapy Unit, Azienda Ospedaliera Universitaria S.Chiara, 56100 - Pisa/IT
  • 12 Molecular Pathology Unit, Azienda Ospedaliera Universitaria Integrata‐Verona, Verona/IT
  • 13 Immunology And Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova/IT
  • 14 Pathology Department, Azienda Ospedaliera-Università di Padova, Padova/IT
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Abstract 2870

Background

There is no established treatment regimen for recurrent glioblastoma (GBM). GBMs have high expression of pro-angiogenic factors and activation of multiple signaling pathways in the tumor microenvironment, including the receptor tyrosine kinases, VEGFR, FGFR, and PDGFR. Regorafenib (Reg), an oral multikinase inhibitor, inhibits these angiogenic kinases and the mutant oncogenic kinases KIT, RET, and B-RAF.

Methods

The primary aim of this academic trial was to assess Reg activity in prolonging overall survival (OS) in patients (pts) with relapsed GBM after surgery and Stupp regimen (a=0.2, 1-sided; b=0.2). Secondary objectives were disease control rate (DCR), safety, progression free survival (PFS), quality of life (QoL) and analysis of angiogenic and metabolic tissue biomarkers as possible predictors of response to Reg. Eligible pts with histologically confirmed GBM, ECOG PS 0‐1, and documented disease progression were randomized 1:1 to Reg 160 mg/day (3 weeks on, 1 week off) or lomustine (Lom) 110 mg/m2 (every 6 weeks) until disease progression or unacceptable toxicity. Tumor response was evaluated by gadolinium brain MRI every 8 weeks according to the RANO criteria.

Results

Between November 2015 and February 2017, 119 pts were enrolled (n = 59 Reg; n = 60 Lom) and stratified for surgery at recurrence; baseline characteristics were balanced. Median age was 57.3 yrs and MGMT was methylated in 47.5% and 44.1% of Reg and Lom pts, respectively. 27 pts (22.7%) had surgery at recurrence. At the time of analysis 73 pts had died. Median OS was 6.5 months(m) (95% CI 5.6–12.0) for REG and 5.5m (95% CI 4.7–8.0) for Lom (HR=0.64; 80% CI 0.47–0.87; p = 0.028, 1-sided log-rank test). DCR (CR+PR+SD) was 44.8% and 21.1% (p = 0.009) for Reg and Lom, respectively. The 6-month PFS rates were 15.5% and 8.3% for Reg and Lom (HR = 0.69; 95% CI 0.47–1.01; p = 0.051). Grade ≥3 adverse events were reported in 56% and 40% of pts who received Reg and Lom.

Conclusions

In this randomized, controlled study we report for the first time Reg activity in pts with relapsed GBM. Reg significantly improved OS and DCR in recurrent GBM compared to Lom. Reg administration was feasible and safe. QoL and biomarker analyses are ongoing.

Clinical trial identification

EudraCT Number: 2014‐003722‐41.

Legal entity responsible for the study

Veneto Institute of Oncology

Funding

Veneto Institute of Oncology and Bayer

Disclosure

All authors have declared no conflicts of interest.

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