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Annals of Oncology<br />
1491P RESPONSE TO SORAFENIB IN PDGFRA-D842V MUTATED<br />
METASTATIC GASTROINTESTINAL STROMAL TUMOR<br />
(GIST), SUPPORTED BY BIOMOLECULAR FUNCTIONAL<br />
ANALYSES<br />
E. Fumagalli1 , S. Pilotti2 , E. Conca2 , R. Bertulli1 , M. Fiore3 , C. Morosi4 , F. Bozzi2 ,<br />
P.G. Casali1 , E. Tamborini2 1<br />
Adult Mesenchymal Tumour Medical Oncology Unit, Fondazione IRCCS Istituto<br />
Nazionale dei Tumori, Milan, Milan, ITALY, 2 Laboratory of Molecular Pathology,<br />
Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, ITALY, 3 Department of<br />
Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori Milan, Milan, ITALY,<br />
4<br />
Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori,<br />
Milan, Milan, ITALY<br />
Background: In GIST, KIT/PDGFRA mutations correlate with response to TKI. The<br />
exon 18 PDGFRA-D842V mutation is known to be resistant to imatinib and<br />
sunitinib. Activation of PDGFRA involves two main signal transduction pathways,<br />
RAS/MEK/ERK, which involves BRAF, and PI3K-AKT. We used sorafenib in three<br />
pts with a PDGFRA-D842V mutated metastatic GIST.<br />
Methods: Since January 2010, 3 PDGFRA-D842V mutated GIST pts (age: 57, 71, 72<br />
yrs) have been treated with sorafenib 400 mg twice daily, on an individual use basis.<br />
Two pts were progressing on imatinib in association to mTOR inhibitors (sirolimus<br />
and everolimus), while <strong>the</strong> third had four previous lines of <strong>the</strong>rapy. Molecular/<br />
biochemical analyses were performed on cryopreserved material taken before<br />
sorafenib treatment in two of <strong>the</strong> three patients (one biopsy and one surgical<br />
specimen). A primary cell culture was obtained from one patient.<br />
Results: One pt had a Choi’s response 3 mos after starting <strong>the</strong> treatment; <strong>the</strong> o<strong>the</strong>rs<br />
a RECIST response at 2 mos. The first pt had a tumor progression after 12 mos from<br />
starting <strong>the</strong>rapy and 9 mos from tumor response. The second pt had a partial<br />
response lasting 15 mos. Treatment was relatively well tolerated, with G3 skin toxicity<br />
in one pt, causing a dose reduction. Biochemical analyses on pretreatment tumors<br />
revealed activated S6K and S6, both downstream mTOR, as well as ERK1/2 strong<br />
activation. The primary cell culture was treated with sorafenib 0.5 and 1 µM and<br />
phosphorylation switch-off of both S6K and S6 (Ser 240/244), associated with a<br />
retained ERK1/2 expression/activation, was observed. Fur<strong>the</strong>r analyses are ongoing to<br />
verify which pathways converging on mTOR are inhibited by sorafenib.<br />
Conclusions: In <strong>the</strong> unresponsive PDGFRA-D842V mutated GIST we saw clinical<br />
signs of antitumor activity of sorafenib in 3 pts. This was consistent with biochemical<br />
analyses, which showed an inhibitory effect downstream mTOR. This clinical setting<br />
constitutes a high-priority unmet medical need, since very few clinical data are<br />
known and no functional analyses on sorafenib activity have been reported so far.<br />
Disclosure: P.G. Casali: Advisory role and honoraria for lectures: Novartis Pharma,<br />
Pfizer. Advisory role: Bayer. All o<strong>the</strong>r authors have declared no conflicts of interest.<br />
1492P MONITORING OF PATIENTS WITH GASTROINTESTINAL<br />
STROMAL TUMOUR: SHOULD THE CHEST BE SCANNED?<br />
A. Findlay 1 , T. Ishfaq 1 , A. Raja 1 , A. Thacoor 1 , P. Hall 2 , M. Marples 3<br />
1 School of Medicine, University of Leeds, Leeds, UNITED KINGDOM, 2 Leeds<br />
Institute of Health Sciences, University of Leeds, Leeds, UNITED KINGDOM, 3 St<br />
James’s Institute of Oncology, St James’s University Hospital, Leeds, UNITED<br />
KINGDOM<br />
Introduction: Thoracic CT scanning is often used for monitoring patients with<br />
sarcoma and upper gastrointestinal carcinoma, but its role in monitoring<br />
gastrointestinal stromal tumour (GIST) is variably defined in guidelines. In line with<br />
study protocols, it has been our practice to include chest CT for monitoring patients<br />
with GIST, and we now report <strong>the</strong> role of <strong>the</strong>se scans.<br />
Method: We reviewed <strong>the</strong> electronic records of all patients diagnosed with GIST at St<br />
James’s Institute of Oncology, Leeds, UK, between 1 January 2001 and 1 January<br />
2011. Primary site, stage at diagnosis, pattern of metastatic disease and frequency of<br />
CT scans were recorded.<br />
Results: We identified 176 patients diagnosed with GIST. All patients had CT scans<br />
of <strong>the</strong> chest, abdomen and pelvis performed at intervals agreed by <strong>the</strong> Yorkshire<br />
Sarcoma Network. Primary site was stomach in 96 patients (55%), small bowel in 27<br />
(15%), rectum in 5 (3%), o<strong>the</strong>r sites in 38 (22%), and unknown in 10 (6%). Median<br />
follow-up was 34.3 months. Of <strong>the</strong> 139 patients who had no metastases at<br />
presentation, five developed local recurrence and 11 developed metastases. 27<br />
patients had metastases at presentation, and <strong>the</strong> status of 10 was unknown. All<br />
patients with metastases had disease below <strong>the</strong> diaphragm, and only two had lung<br />
involvement as well (one at recurrence, one at initial presentation). Thirty-seven<br />
patients with metastatic disease were treated with imatinib. Of <strong>the</strong> 31 patients who<br />
progressed on imatinib, all had progression below <strong>the</strong> diaphragm; <strong>the</strong> patient with<br />
lung and abdominal metastases progressed in both areas. Four of <strong>the</strong>se patients also<br />
developed lung metastases at <strong>the</strong> time of progression elsewhere.<br />
Conclusions: We observed synchronous progression in lungs and abdomen in 5/31<br />
patients progressing on imatinib (16%), but no patients in our cohort relapsed or<br />
progressed in <strong>the</strong> lungs alone. We conclude that progression confined to <strong>the</strong> lungs is<br />
rare in GIST. Patients being monitored for recurrence or progression should have CT<br />
scans of <strong>the</strong> abdomen and pelvis only, with completion CT of <strong>the</strong> thorax being<br />
reserved for baseline and progression of disease.<br />
Disclosure: M. Marples: Dr Marples has accepted sponsorship to research meetings<br />
from Novartis. Novartis support mutation testing for GIST at Dr Marples’<br />
institution. All o<strong>the</strong>r authors have declared no conflicts of interest.<br />
1493P RESULTS OF HRQOL DATA FROM PALETTE: A<br />
RANDOMIZED DOUBLE BLIND PHASE III TRIAL OF<br />
PAZOPANIB VERSUS PLACEBO IN METASTATIC SOFT<br />
TISSUE SARCOMA (STS) PATIENTS. AN EORTC STBSG<br />
GLOBAL NETWORK STUDY (EORTC 62072)<br />
C. Coens 1 , W.T.A. van der Graaf 2 , J. Blay 3 , S.P. Chawla 4 , D. Kim 5 ,<br />
R. Sanfilippo 6 , S. Manson 7 , M. Ouali 8 , S. Marreaud 9 , A. Bottomley 1<br />
1 Quality of Life Department, EORTC HQ, Brussels, BELGIUM, 2 Medical<br />
Oncology /452, Radboud University Medical Centre NijmegenUniversity Medical<br />
Center St. Radboud, Nijmegen, NETHERLANDS, 3 University Claude Bernard<br />
Lyon I, Centre L, Lyon Cedex, FRANCE, 4 Clinical Research, Sarcoma Oncology<br />
Center, Los Angeles, CA, UNITED STATES OF AMERICA, 5 Internal Medicine,<br />
Seoul National University Hospital, Seoul, KOREA, 6 Cancer Medicine<br />
Department, Istituto Nazionale dei Tumori, Milano, ITALY, 7 R&D,<br />
GlaxoSmithKline, Uxbridge, UNITED KINGDOM, 8 Statistical Department, EORTC<br />
HQ, Brussels, BELGIUM, 9 Medical Department, EORTC HQ, Brussels,<br />
BELGIUM<br />
Background: HRQoL was an important secondary endpoint in this global<br />
double-blind, randomised phase III trial of pazopanib 800 mg QD versus placebo as<br />
second or later line treatment for advanced STS patients (N = 369) where progression<br />
free survival was significantly improved in <strong>the</strong> pazopanib arm (median: 4.6 versus 1.6<br />
months; hazard ratio = 0.31; P < 0.001), but no statistically significant difference was<br />
observed in overall survival. Toxicity of pazopanib consisted mainly of fatigue,<br />
diarrhea, nausea weight loss and hypertension.<br />
Methods: HRQoL was assessed using EORTC QLQ-C30 at baseline, week 4, 8 and<br />
12 in patients who were progression free. The primary HRQoL endpont was <strong>the</strong><br />
QLQ-C30 global health scale, analyzed using linear mixed modeling supplemented<br />
with sensitivity analyses using alternative scales, methods and imputation of missing<br />
data.<br />
Results: Compliance of HRQoL was good in this trial, ranging from 94% at baseline<br />
to 81% at week 12. Placebo patients completed fewer questionnaires, largely due to a<br />
higher progression rate (median number of completed questionnaires- pazopanib: 3<br />
vs placebo: 2). Differences in <strong>the</strong> global health scale between <strong>the</strong> two treatment arms<br />
assessed at weeks 4, 8 and 12 were not significant and did not exceed <strong>the</strong><br />
pre-determined minimally important difference of 10 points (P = 0.291; average<br />
difference = 2.6 points). The EQ-5D data and sensitivity analyses mainly confirmed<br />
this finding. Among <strong>the</strong> o<strong>the</strong>r scales, <strong>the</strong> pazopanib arm reported significantly worse<br />
symptom scores for diarrhea (P < 0.001), loss of appetite (P < 0.001), nausea/vomiting<br />
(P < 0.001) and fatigue (P = 0.012). On <strong>the</strong> pazopanib arm, 74.8% of patients<br />
reported at least one minimally important worsening in any of those four symptom<br />
scales, compared to 51.2% on <strong>the</strong> placebo arm. In general, HRQoL scores tended to<br />
decline over time in both arms, indicative of <strong>the</strong> underlying disease. Exploratory<br />
factor analysis revealed that global health was associated mainly with functioning<br />
scales (Physical, Role and Social) and less with symptom scales except for fatigue.<br />
Conclusion: The toxicity profile of pazopanib is reflected in <strong>the</strong> patients’<br />
self-reported symptoms but did not translate into worse overall global health while<br />
on-treatment, as patients maintained continued good functioning.<br />
Disclosure: J. Blay: research support and honoraria from GSK, Novartis, Roche,<br />
MSD, PharmaMar. S.P. Chawla: consultant GSK. D. Kim: consultant GSK, MEK<br />
Advisory Board. R. Sanfilippo: Honoraria from GSK. S. Manson: employee of GSK,<br />
holds GSK shares. A. Bottomley: Funding for EORTC research projects from Roche,<br />
Genentech, BMS. All o<strong>the</strong>r authors have declared no conflicts of interest.<br />
1494P IMATINIB MESYLATE IN D<strong>ESMO</strong>PLASTIC SMALL ROUND<br />
CELL TUMOUR<br />
A.F. Bertuzzi 1 , G. Bisogno 2 , M. Carli 2 , A. Ferrari 3 , A. Comandone 4 , M. Gasco 1 ,<br />
R. De Sanctis 1 , C. Gnocchi 5 , A. Santoro 1<br />
1 Medical Oncology and Hematology, Humanitas Cancer Center, IRCCS,<br />
Rozzano, ITALY, 2 Pediatric Medical Oncology and Hematology, Clinica di<br />
Onco-Ematologia Pediatrica, Padova, ITALY, 3 Pediatric Oncology Unit,<br />
Fondazione IRCCS - Istituto Nazionale dei Tumori, Milano, ITALY, 4 Medical<br />
Oncology, Ospedale Gradenigo, Torino, ITALY, 5 Novartis Farma, Novartis,<br />
Origgio, ITALY<br />
Introduction: Desmoplastic small round cell tumor (DSRCT) is a very rare and<br />
aggressive mesenchymal neoplasia with an extremely poor prognosis. The typical<br />
translocation t(11;22) determines <strong>the</strong> overexpression of PDGF-Rα and β, responsible<br />
of clinical stromal fibrosis reaction constantly detected in abdominal lesions. We<br />
investigated <strong>the</strong> role of imatinib, as tyrosine kinase inhibitor of PDGF-R, in DSRCT.<br />
Volume 23 | Supplement 9 | September <strong>2012</strong> doi:10.1093/annonc/mds414 | ix483