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Poster Discussion session -Gastrointestinal, non-colorectal

1812 - Ramucirumab as second-line treatment in patients with advanced hepatocellular carcinoma (HCC) and elevated alpha-fetoprotein (AFP) following first-line sorafenib: patient reported outcome results across two phase 3 studies (REACH-2 and REACH)

Date

19 Oct 2018

Session

Poster Discussion session -Gastrointestinal, non-colorectal

Presenters

Andrew Zhu

Citation

Annals of Oncology (2018) 29 (suppl_8): viii205-viii270. 10.1093/annonc/mdy282

Authors

A.X. Zhu1, R.S. Finn2, P.R. Galle3, J.M. Llovet4, J.F. Blanc5, T. Okusaka6, I. Chau7, D. Cella8, A. Girvan9, J. Gable10, L. Bowman10, Y. Hsu11, P.B. Abada12, M. Kudo13

Author affiliations

  • 1 Department Of Hematology/oncology, Massachusetts General Hospital, 02114 - Boston/US
  • 2 Los Angeles Medical Center, University of California, 90095 - Los Angeles/US
  • 3 First Department Of Internal Medicine, Universitätsmedizin Mainz, 55131 - Mainz/DE
  • 4 Barcelona Clinic Liver Cancer Group, Hospital Clinic Barcelona, 08036 - Barcelona/ES
  • 5 Department Of Hepato-gastroenterology And Medical Oncology, CHU Bordeaux Hopital St. André, 33000 - Bordeaux/FR
  • 6 Hepatobiliary And Pancreatic Oncology, National Cancer Center Hospital, 104-0045 - Tokyo/JP
  • 7 Deaprtment Of Medicine  , The Institute of Cancer Research/Royal Marsden NHS Foundation Trust, SM2 5PT - Sutton/GB
  • 8 Robert H. Lurie Comprehensive Cancer Center, Northwestern University, IL 60611 - Chicago/US
  • 9 Global Health Outcomes, Eli Lilly and Company, 46285 - Indianapolis/US
  • 10 Global Patient Outcomes, Eli Lilly and Company, Indianapolis/US
  • 11 Statistics, Eli Lilly and Company, New York/US
  • 12 Oncology, Eli Lilly, 46285 - Indianapolis/US
  • 13 Department Of Gastroenterology And Hepatology, Kindai University Faculty of Medicine, Osaka/JP
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Resources

Abstract 1812

Background

Ramucirumab (RAM) was studied in patients with advanced HCC and AFP≥400 ng/mL following sorafenib in two global, randomized, double-blind, placebo (PL)-controlled phase 3 studies. REACH-2 met its primary endpoint demonstrating an improved overall survival (OS) for RAM treatment compared to PL, consistent with the benefit observed in pre-specified patients with AFP ≥400 ng/mL in REACH. Patient reported outcome (PRO) analyses of disease-related symptoms in patients from REACH-2, and pooled with patients from REACH with baseline AFP ≥400 ng/mL were performed.

Methods

Eligible patients had advanced HCC, Child-Pugh A, ECOG PS 0 or 1, AFP ≥400 ng/mL, and prior sorafenib. Patients received RAM 8 mg/kg or PL Q2W. PROs were assessed by Functional Assessment of Cancer Therapy (FACT) Hepatobiliary Symptom Index (FHSI)-8 at baseline, Q6W and end of treatment. Deterioration in FHSI-8 was defined as ≥ 3-point decrease in total score, or a decrease in one categorical response for an individual item. Time to deterioration (TTD) was time from the date of randomization to the first date of deterioration.Table: 622PD

Time to deterioration of FHSI-8

Analysis populationREACH-2 N = 292 (RAM 197, PL 95)REACH AFP ≥400 ng/mL N = 250 (RAM 119, PL 131)Pooled REACH-2, REACH AFP ≥400 ng/mL N = 542 (RAM 316, PL 226)
Total score, median3.7 mo RAM vs 2.8 mo PL2.9 mo RAM vs 1.6 mo PL3.3 mo RAM vs 1.9 mo PL
HR (95% CI)
Total score0.799 (0.545, 1.171)0.690 (0.470, 1.014)0.725 (0.559, 0.941)
Lack of energy1.098 (0.741, 1.627)0.884 (0.605, 1.292)0.942 (0.724, 1.225)
Nausea0.809 (0.498, 1.315)0.931 (0.586, 1.479)0.821 (0.589, 1.145)
Pain0.976 (0.651, 1.465)0.641 (0.427, 0.962)0.769 (0.588, 1.005)
Weight loss0.745 (0.473, 1.172)0.771 (0.467, 1.273)0.699 (0.505, 0.969)
Back pain0.564 (0.364, 0.876)0.743 (0.486, 1.137)0.668 (0.497, 0.899)
Fatigue0.845 (0.584, 1.221)0.775 (0.525, 1.142)0.813 (0.626, 1.056)
Jaundice or yellow color or skin0.592 (0.237, 1.476)0.963 (0.461, 2.011)0.725 (0.411, 1.278)
Discomfort or pain in stomach area0.962 (0.636, 1.455)1.062 (0.705, 1.601)1.017 (0.767, 1.349)

Results

Analysis populations included REACH-2, REACH AFP ≥400 ng/mL, and the two populations pooled. FHSI-8 compliance was acceptable. Similar to REACH patients with AFP ≥400 ng/mL, RAM patients in REACH-2 reported a positive trend in TTD in FHSI-8 total score compared to PL. A similar trend was observed in most individual items, including a significant delay in back pain progression. In the pooled population, RAM treatment significantly delayed total FHSI-8 TTD, including the back pain, weight loss, and pain items, relative to PL.

Conclusions

Ramucirumab is the only agent specifically investigated in second line HCC patients with AFP >400 ng/mL to demonstrate a consistent trend for a benefit in disease-related symptoms.

Clinical trial identification

NCT02435433; NCT01140347.

Legal entity responsible for the study

Eli Lilly and Company.

Funding

Eli Lilly and Company.

Editorial Acknowledgement

Nathalie Godinot of Eli Lilly and Company provided medical writing support.

Disclosure

A.X. Zhu: Consulting or advisory role: Eisai, Bristol-Myers Squibb, Merck, Novartis, Sanofi, AstraZeneca, Bayer, Exelixis, Eli Lilly; Research funding: Eli Lilly, Bayer, Bristol-Myers Squibb, Novartis, Merck. R.S. Finn: Consulting: AstraZeneca, Bayer, Bristol-Myers Squibb, Eli Lilly, Pfizer, Merck, Novartis, Roche/Genentech. P.R. Galle: Consulting or advisory roles: Bayer Schering Pharma, Sirtex Medical, Eli Lilly, Bristol-Myers Squibb, MSD; Honoraria: Eli Lilly, Bristol-Meyers Squibb, Sillagen, Bayer Schering Pharma, Sirtex Medical. J.M. Llovet: Consulting: Lilly, Bayer, Bristol-Myers Squibb, Blueprint Medicines, Eisai, Celsion, Boehringer Ingelheim, Incyte; Research funding; Bayer Schering Pharma, Blueprint medicines, Boehringer Ingelheim, Incyte and Bristol-Myers Squibb. J.F. Blanc: Personal fees: Lilly, Bayer, BMS, Esai, Ipsen, Onxeo, during the conduct of the study. T. Okusaka: Research grants, Honoraria, Advisory role: Eli Lilly, Novartis Pharma K.K., Kowa K.K., Takeda, Nippon Boehringer Ingelheim, Dainippon Simitomo Pharma, Pfizer Jana, Bayer Yakuhin, Chugai Pharmaceutical, Yakuruto Honsha, Ono Pharmaceutical, Eisai, AstraZeneca, Merck Serono, OncoTherapy Science, Kyowa Hakko Kirin, Shizuoka Industry, Baxter, Nano Carrier, Zeria Pharmaceutical, Glaxo Smith Kline K.K., Nobelpharma, Bristol-Myers Squibb, Nipponchemofa, EA Pharma, Fujifilm RI Pharma, Astellas Pharma, Nippon Kayaku, Daiichi Sankyo, Celgene, MSD, Teijin Pharma. I. Chau: Advisory board: Sanofi Oncology, Eli-Lilly, Bristol-Myers Squibb, MSD, Bayer, Roche, Merck Serono, Five Prime Therapeutics; Research funding: Eli-Lilly, Janssen-Cilag, Sanofi Oncology, Merck-Serono, Novartis; Honorarium: Taiho, Pfizer, Amgen, Eli-Lilly. D. Cella: Personal fees: Lilly, during the conduct of the study, Other: FACIT.org, outside the submitted work. A. Girvan, J. Gable, L. Bowman, Y. Hsu, P.B. Abada: Employee and minor shareholder: Eli Lilly and Company. M. Kudo: Consulting or advisory role: Kowa, MSD, Bristol-Myers Squibb, Bayer, Chugai Pharma, Taiho Pharmaceutical; Honoraria: Bayer, Eisai, MSD, Ajinomoto; Research funding: Chugai Pharma, Otsuka, Takeda, Taiho Pharmaceutical, Sumitomo Dainippon, Dalichi Sankyo, MSD, Eisai, Bayer, Abbvie.

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