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Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017 EGFR+ NSCLC and by central testing documented presence of pretreatment T790M mutation. Seventy-three patients will receive continuous treatment with osimertinib 80 mg daily until disease progression, intolerable adverse events, consent withdrawal or noncompliance with the study protocol. The primary endpoint is the objective response rate (ORR) assessed using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. The trial is designed to detect a ≥70% ORR in this patient population. Secondary objectives include PFS, overall survival, time to treatment failure, duration of response and disease control rate. Additional pre-specified secondary objectives of the study are the longitudinal analysis of EGFR mutations (including the T790M and the C797S mutations) in plasma and serum and the expression analysis of a panel of biomarkers with possible predictive value for osimertinib treatment. Results: Not applicable Conclusion: Not applicable Keywords: EGFR T790M mutation, AZENT study, AZD9291, EGFR mutant NSCLC POSTER SESSION 2 – P2.06: SCIENTIFIC CO-OPERATION/RESEARCH GROUPS PHASE II + NK – TUESDAY, DECEMBER 6, 2016 P2.06-011 PHASE 2 STUDY OF MM-121 PLUS CHEMOTHERAPY VS. CHEMOTHERAPY ALONE IN HEREGULIN-POSITIVE, LOCALLY ADVANCED OR METASTATIC NSCLC Lecia Sequist 1 , Ian Anderson 2 , Akin Atmaca 3 , Todd Bauer 4 , Young Chae 5 , Haiying Cheng 6 , Manuel Cobo 7 , Nate Demars 8 , Enriqueta Felip 9 , Nikolaj Frost 10 , Ramón García Gómez 11 , Jhanelle Gray 12 , Wael Harb 13 , Leora Horn 14 , Rudolf Huber 15 , Dolores Isla 16 , Arthur Kudla 8 , Jean Lee 17 , Sara Mathews 8 , Ranee Mehra 18 , Manuel Modiano 19 , Jorge Nieva 20 , Joseph Rosales 21 , Frances Shepherd 22 , Alexander Spira 23 , Akos Czibere 8 1 Massachusetts General Hospital, Boston/MA/United States of America, 2 St. Joseph Heritage Medical Group, Santa Rosa/CA/United States of America, 3 Krankenhaus Nordwest GmbH Institut Für Klinisch-Onkologische Forschung, Frankfurt Am Main/ Germany, 4 Sarah Cannon Research Institute, Tennessee Oncology, PLCC, Nashville/ TN/United States of America, 5 Northwestern University, Chicago/IL/United States of America, 6 Montefiore Medical Center, Bronx/NY/United States of America, 7 H.R.U. de Málaga, Malaga/Spain, 8 Merrimack Pharmaceuticals, Cambridge/MA/ United States of America, 9 Hospital Universitario Vall D’Hebron, Barcelona/Spain, 10 Charité - Universitätsmedizin Berlin, Berline/Germany, 11 H.G.U. G. Marañón, Madrid/Spain, 12 Thoracic Oncology, Moffitt Cancer Center, Tampa/FL/United States of America, 13 Horizon Oncologycenter, Lafayette in/IN/United States of America, 14 Vanderbilt–Ingram Comprehensive Cancer Center, Nashvillle/TN/United States of America, 15 Klinikum Der Universitaet Muenchen, Lmu, München/Germany, 16 Medical Oncology, H.C.U.Lozano Blesa, Zaragoza/Spain, 17 NYU Medical Center, New York/NY/United States of America, 18 Fox Chase Cancer Center, Philadelphia/ PA/United States of America, 19 Arizona Clinical Research Center, Tucson/AZ/ United States of America, 20 University of Southern California, Los Angeles/CA/ United States of America, 21 Virginia Mason, Seattle/WA/United States of America, 22 Princess Margaret Cancer Centre, Toronto/ON/Canada, 23 Virginia Cancer Specialists, Arlington/VA/United States of America Background: The role of the HER3 receptor and its ligand heregulin (HRG) in the progression of multiple cancers has been well established. Seribantumab (MM-121) is a fully human, monoclonal IgG2 antibody that binds to the HRG domain of HER3, blocking HER3 activity. The correlation between the level of HRG mRNA in tumor tissue and progression free survival (PFS) were retrospectively analyzed in three completed randomized Phase 2 studies of seribantumab plus standard of care (SOC) versus SOC alone (NSCLC, breast cancer and ovarian cancer). In each of these studies, high levels of HRG mRNA predicted shortened PFS for patients who received SOC treatment, while the addition of seribantumab to SOC improved PFS for patients with HRG-positive (HRG+) tumors. This is consistent with the hypothesis that HRG expression defines a drug tolerant cancer cell phenotype shielded from the effects of cytotoxic or targeted therapies and that blockade of HRG-induced HER3 signaling by seribantumab counters the effects of HRG on cancer cells, with the potential to improve outcomes for HRG+ patients. It is estimated that up to approximately 50% of cases of all solid tumor indications are HRG+. This HRG expression may contribute to rapid clinical progression in a subset of patients with poor prognosis. Methods: In the ongoing randomized, open-label, international, Phase 2 study, NSCLC patients with HRG+ tumors are being prospectively selected using a HRG RNA in situ hybridization assay performed on a recent tumor tissue sample collected via fine needle aspiration, core needle biopsy or excision. Approximately 560 patients will be screened to support enrollment of 280 HRG+ patients, who will be randomized in a 2:1 ratio to receive seribantumab plus investigator’s choice of docetaxel or pemetrexed, or docetaxel or pemetrexed alone. Patients will be wild-type for EGFR and ALK and will have progressed following one to three systemic therapies, one of which must be an anti-PD-1 or anti-PD-L1 therapy, for locally advanced and/or metastatic disease. Overall survival (OS) is the primary endpoint of the study and secondary endpoints include PFS, objective response rate and time to progression. Safety and health-related quality of life will also be assessed. An interim analysis is planned when 50% of final OS events have been reported. Enrollment has been initiated with approximately 80 sites expected to participate worldwide. Clinical Trials Registry number: NCT02387216 Results: Section not applicable Conclusion: Section not applicable Keywords: Heregulin, HER3, Seribantumab, MM-121 POSTER SESSION 2 – P2.06: SCIENTIFIC CO-OPERATION/RESEARCH GROUPS PHASE II + NK – TUESDAY, DECEMBER 6, 2016 P2.06-012 PHASE 2 STUDY OF ABEMACICLIB + PEMBROLIZUMAB IN KRAS MUTATION, PD-L1+, STAGE IV NON-SMALL CELL OR SQUAMOUS CELL LUNG CANCER Julien Mazieres 1 , Sara Tolaney 2 , Luis Paz-Ares 3 , Jean-Louis Pujol 4 , Tuncay Goksel 5 , Chia-Chi Lin 6 , Anwar Hossain 7 , William John 7 , Peter Kabos 8 1 Hôpital Rangueil, Toulouse/France, 2 Dana-Farber Cancer Institute, Boston/MA/ United States of America, 3 Doce de Octubre University Hospital, Madrid/Spain, 4 Hôpital Arnaud de Villeneuve Service de, Montpellier/France, 5 Ege University Medical School, Izmir/Turkey, 6 National Taiwan University Hospital, Taipei/Taiwan, 7 Eli Lilly and Company, Indianapolis/IN/United States of America, 8 University of Colorado Anschutz Medical Campus, Aurora/CO/United States of America Background: Stage IV non-small cell lung cancer (NSCLC) harboring KRAS mutations remains a treatment challenge. Abemaciclib, a small molecular inhibitor of both cyclin-dependent kinase (CDK) 4 and CDK6, demonstrated acceptable safety, tolerability, and single-agent activity for patients with different tumors, including NSCLC. Preclinical evidence suggests a lethal interaction between CDK4 inhibition in lung cells and KRAS oncogenes. Pembrolizumab, a humanized monoclonal antibody against PD-1 protein, is approved in the US for patients with metastatic PD-L1+ NSCLC. Both compounds demonstrated manageable toxicities. We thus aim to study the combination of abemaciclib and pembrolizumab in pretreated patients with NSCLC. Methods: This open-label phase 2 study will evaluate safety and preliminary efficacy of abemaciclib 150 mg given orally every 12 hours on a continuous schedule on days 1-21 in combination with intravenous pembrolizumab 200 mg on day 1 of a 21-day cycle to patients in 1 of 3 disease cohorts: KRAS mutation, PD-L1+, stage IV NSCLC (Part A); stage IV NSCLC with squamous histology (Part B); or hormone receptor+, HER2- metastatic breast cancer (Part C). Total target accrual is approximately 75 patients (25 per cohort). Only the 2 NSCLC cohorts will be presented here. Patients eligible for Part A have a confirmed KRAS mutation, PD-L1+ expression score of ≥1%, and are chemotherapy-naïve for metastatic NSCLC. Part B includes patients with predominately squamous NSCLC who have received 1 prior platinum-based chemotherapy for advanced NSCLC. Patients must provide tumor tissue before and after treatment (cycle 3, day 1); have measurable disease, adequate organ function, an ECOG PS ≤1, and a life expectancy ≥12 weeks; and be ≥18 years of age and able to swallow oral medications. The primary objective is to characterize the safety profile of abemaciclib plus pembrolizumab. Secondary objectives include objective response rate (ORR), disease control rate (DCR), duration of response (DoR), progression-free survival (PFS), characterization of pharmacokinetics, and health outcomes. Patients who receive any study drug will be included in the analyses. Analyses of ORR, DCR, DoR, and PFS will be evaluated according to RECIST v.1.1 and irRECIST. Time-to-event variables will be estimated by Kaplan-Meier methodology. An interim analysis of safety and preliminary efficacy may occur after all patients have completed (or discontinued from) approximately 24 weeks of treatment. The final OS analysis will occur based on data collected for approximately 12 months after the last patient receives treatment. Results: Section not applicable Conclusion: Section not applicable Keywords: abemaciclib, pembrolizumab, non-small cell lung cancer, Squamous cell lung cancer POSTER SESSION 2 – P2.06: SCIENTIFIC CO-OPERATION/RESEARCH GROUPS PHASE II + NK – TUESDAY, DECEMBER 6, 2016 P2.06-013 AFATINIB IN PATIENTS WITH ADVANCED HER2 MUTATION-POSITIVE (M+) NSCLC PREVIOUSLY TREATED WITH CHEMOTHERAPY Caicun Zhou 1 , Yun Fan 2 , Huijuan Wang 3 , Chong Kin Liam 4 , Chengjie Hu 5 , Agnieszka Cseh 6 1 Medical Oncology, Shanghai Pulmonary Hospital, Shanghai/China, 2 Department of Chemotherapy, Zhejiang Cancer Hospital, Hangzhou/China, 3 Department of Internal Medicine, Henan Cancer Hospital/the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou/China, 4 Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur/Malaysia, 5 Boehringer Ingelheim (China) Investment Co. Ltd, Beijing/China, 6 Department of Medical Affairs, Boehringer Ingelheim Rcv GmbH & Co. KG, Vienna/Austria S564 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017 Background: Afatinib, an irreversible ErbB family blocker, inhibits signalling from all homo- and hetero-dimers of ErbB family members (EGFR [ErbB1], HER2 [ErbB2], ErbB3 and ErbB4). Based on the results of two large Phase III trials (LUX-Lung 3 [LL3] and LL6), afatinib is approved in many countries for first-line treatment of patients with advanced EGFRm+ NSCLC. More recently, following results of the Phase III LL8 trial, afatinib was also approved for treatment of squamous cell carcinoma of the lung after platinum-based chemotherapy. Overexpression/amplification of HER2 has been identified in NSCLC and may have a role in acquired resistance to reversible EGFR tyrosine kinase inhibitors. Afatinib has demonstrated preclinical activity in HER2m+ lung cancer models and clinical activity in HER2m+ NSCLC patients (de Greve et al. Lung Cancer 2012; Mazieres et al. Ann Oncol 2015). This Phase II trial investigates the efficacy and safety of afatinib in patients with advanced NSCLC harbouring HER2 mutations, previously treated with chemotherapy (NCT02597946). Methods: In this Phase II, open-label, single-arm trial, eligible patients are aged ≥18 years, with ECOG PS 0/1, histologically or cytologically confirmed stage IV NSCLC, confirmed HER2m+ tumour tissue, and measurable disease (RECIST v1.1), following failure of one or two prior chemotherapy regimens, of which one is platinum-based. Prior radiotherapy (except palliative treatment), chemotherapy or immunotherapy within 4 weeks, hormonal therapy within 2 weeks, or EGFR/HER2-targeted therapy is not allowed. In Part A of this two-part trial, patients will receive continuous oral afatinib monotherapy at the approved starting dose of 40 mg/day. The dose may be escalated to 50 mg/day after 4 weeks in patients with minimal drug-related adverse events (AEs); dose reduction by 10-mg decrements to a minimum of 20 mg/day will occur in case of drug-related grade ≥3 or selected grade 2 AEs. In Part B, patients with ECOG PS ≤2 experiencing >12 weeks of clinical benefit with afatinib monotherapy before disease progression will continue treatment with afatinib plus weekly intravenous paclitaxel 80 mg/m 2 . In Parts A and B, treatment will continue until disease progression or intolerable AEs. The primary endpoint is objective response in Part A. Secondary endpoints include: disease control, progression-free survival, time to progression, and duration of response in Part A; and overall survival. Safety will also be assessed. Target enrolment is 40 patients, and participating countries will be listed in the full presentation. Results: Section not applicable. Conclusion: Section not applicable. Keywords: NSCLC, afatinib, HER2, phase II POSTER SESSION 2 – P2.06: SCIENTIFIC CO-OPERATION/RESEARCH GROUPS PHASE II + NK – TUESDAY, DECEMBER 6, 2016 P2.06-014 PHASE 2 STUDY OF GLESATINIB OR SITRAVATINIB WITH NIVOLUMAB IN NON-SMALL CELL LUNG CANCER (NSCLC) AFTER CHECKPOINT INHIBITOR THERAPY John Nemunaitis 1 , Hossein Borghaei 2 , Wallace Akerley 3 , Shirish Gadgeel 4 , Alexander Spira 5 , Igor Rybkin 6 , Demiana Faltaos 7 , Isan Chen 7 , James Christensen 7 , Diane Potvin 7 , Karen Velastegui 7 , Matteo Levisetti 7 , Hatim Husain 8 1 Mary Crowley Cancer Research Centers, Dallas/TX/United States of America, 2 Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia/PA/ United States of America, 3 Huntsman Cancer Institute, Salt Lake City/UT/United States of America, 4 Karmanos Cancer Institute, Detroit/MI/United States of America, 5 Virginia Cancer Specialists, Fairfax/AL/United States of America, 6 Henry Ford Health System, Detroit/MI/United States of America, 7 Mirati Therapeutics, San Diego/United States of America, 8 Medical Oncology, Uc San Diego Moores Cancer Center, La Jolla/CA/United States of America Background: Combination therapy with agents that target the molecular and cellular mechanisms of resistance to checkpoint inhibitor therapy (CIT) is a rational approach to restoring or improving the efficacy of CIT in patients with immunotherapy resistant NSCLC. Glesatinib, a tyrosine kinase inhibitor (TKI), which targets Axl, MER and MET RTKs expressed on macrophages and antigen-presenting-cells within the tumor microenvironment (TME), may reverse the immunosuppressive TME and enhance anti-tumor T and NK cell responses by enhancing antigen presentation and T cell effector function. Sitravatinib, also a TKI, which targets VEGFR2 and KIT as well as Axl, MER and MET, may further enhance anti-tumor activity by VEGFR2 and KIT inhibition mediated reduction of regulatory T cells and myeloid-derived suppressor cells (MDSCs). Given these pleiotropic immune activating effects, the combination of glesatinib or sitravatinib with nivolumab is a rational approach to restoring or enhancing the clinical activity of CIT in patients with immunotherapy resistant NSCLC. Methods: This open-label Phase 2 study evaluates the tolerability and clinical activity of the investigational agents, glesatinib or sitravatinib in combination with nivolumab in separate cohorts of patients with non-squamous NSCLC who have experienced progression of disease on or after treatment with CIT. The study begins with a limited dose escalation evaluation of each investigational agent in combination with nivolumab to determine the dose levels to be used in Phase 2. The primary objective is to assess the clinical activity of the combination regimens using the Objective Response Rate (ORR) by RECIST 1.1. Other objectives include safety, tolerability, pharmacokinetics and changes in circulating and tumor cell PD-L1, circulating and tumor infiltrating immune cell populations, cytokines and gene expression signatures. Enrollment into each Phase 2 treatment arm is stratified by prior outcome of CIT (e.g., clinical benefit versus progression of disease in ≤12 weeks). The investigational agents are administered orally in continuous regimens; nivolumab is administered intravenously, 3 mg/kg every 2 weeks. The sample sizes for the treatment arms are based on two-stage Simon Optimal Designs. Status: The US IND opened in June 2016. Results: Section not applicable Conclusion: Section not applicable Keywords: Nivolumab, Immunotherapy resistant NSCLC, TAMs, tyrosine kinase inhibitor POSTER SESSION 2 – P2.06: SCIENTIFIC CO-OPERATION/RESEARCH GROUPS PHASE II + NK – TUESDAY, DECEMBER 6, 2016 P2.06-015 THE NICE SALVAGE STUDY: A PHASE II TRIAL OF WEEKLY NAB-PACLITAXEL IN THE SALVAGE SETTING FOR ADVANCED NON- SMALL CELL LUNG CANCER Takashi Niwa 1 , Hiroshige Yoshioka 2 , Akito Hata 3 , Koichi Azuma 4 , Manabu Tajima 5 , Mitsunori Morita 6 , Yoshihito Kogure 7 , Hiroaki Akamatsu 8 , Tadashi Ishida 2 , Nobuyuki Katakami 9 , Tomoaki Hoshino 10 , Mitsuhiro Takenoyama 11 , Kazuhisa Takahashi 5 , Hiroyasu Kaneda 12 , Hiromi Tomioka 6 , Hideo Saka 7 , Masahiko Ando 13 , Nobuyuki Yamamoto 8 1 Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki/Japan, 2 Kurashiki Central Hospital, Kurashiki/Japan, 3 Institute of Biomedical Research and Innovation, Kobe/Japan, 4 Department of Internal Medicine, Division of Respirology, Neurology, and Rheumatology, Kurume University School of Medicine, Kurume/ Japan, 5 Juntendo University Hospital, Tokyo/Japan, 6 Kobe City Medical Center West Hospital, Kobe/Japan, 7 Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya/Japan, 8 Medical Oncology, Wakayama Medical University Hospital, Wakayama/Japan, 9 Division of Integrated Oncology, Institute of Biomedical Research and Innovation, Kobe/Japan, 10 Department of Internal Medicine, Division of Respirology, Neurology, and Rheumatology, Kurume University School of Medicine, Kurumeshi/Japan, 11 Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka/Japan, 12 Kishiwada City Hospital, Kishiwada/Japan, 13 Center for Advanced Medicine and Clinical Reserch, Nagoya University Hospital, Nagoya/Japan Background: The standard chemotherapy for advanced NSCLC after the failing of second or third line chemotherapy has yet to be established. In these salvage setting patients the acceptable safety and efficacy of solvent-based paclitaxel (sb-P) monotherapy have been previously reported as one possible treatment option (Anticancer Res 2005). Compared with sb-P, nab-paclitaxel(nab-P) yielded a higher mean maximal circulating concentration of free paclitaxel and delivered higher drug concentration to tumors in preclinical xenograft models (Clin. Cancer Res. 2006). Moreover, a large multicenter international phase III study (CA031) of nab-P + carboplatin (C) vs sb-P + C, nab-P + C produced a significantly higher overall response rate (ORR) compared with sb-P + C, and had an acceptable safety profile as a first line chemotherapy (J. Clin. Oncol. 2012) .These results suggest that nab-P monotherapy have possibility to be more efficacious and tolerable compared to sb-P monotherapy. KTOSG trial 1301 has recently revealed weekly nab-P as a second line chemotherapy is associated with acceptable toxicity and a favorable ORR in patients with advanced NSCLC (Lung Cancer 2016). However, there are no reports of nab-P monotherapy after the failing of second or third line chemotherapy. We therefore planned this study aiming to assess the efficacy and safety of nab-P monotherapy for patients in the salvage setting. Methods: This multicenter single arm phase II study assesses the efficacy of nab-P in pts with PS 0-2 and aged < 75 years with advanced nonsmall cell lung cancer. Pts must have failed two or three prior lines of therapy including at least a platinum- containing chemotherapy. Pts pretreated with sb-P or nab-P, or tumors harboring EGFR mutation or ALK fusion gene are excluded. Pts receive nab-P 80 mg/m2 on days 1,8 and 15 of a 28-days cycle. The primary endpoint of the trial is progression-free survival in an intent-totreat analysis using the Kaplan-Meier method and log-rank test. Secondary endpoints include overall survival, ORR, disease control rate, efficacy according to prior docetaxel, quality of life, and safety. The study is powered to detect a 1.5-month improvement in median PFS in this investigational arm beyond the 2.0-month median PFS estimated from historical data. Assuming a one-sided 0.10 level of Type I error and 80% power, the sample size was calculated to be 35 pts based on the Brookmeyer-Crowley method. The target sample size is established as 38 pts. As of June 2016, 14 pts were registered and recruitment is ongoing (UMIN000016173). Results: Section not applicable Conclusion: Section not applicable Keywords: NSCLC, nab paclitaxel, salvage, NICE Copyright © 2016 by the International Association for the Study of Lung Cancer S565
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LILLY ONCOLOGY IS DEDICATED TO ADVA
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Journal Thoracic Oncology

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