Uit de tussenresultaten van de open label fase III EV302 / KEYNOTE-A39 studie blijkt enfortumab vedotin (Padcev) plus immuuntherapie met pembrolizumab (een anti-PD medicijn) de overall overleving en ziektevrije tijd te verdubbelen in vergelijking met chemotherapie bij nog niet eerder behandelde patiënten met lokaal gevorderde en/of uitgezaaide blaaskanker / urineleiderkanker.
De studie vergelijkt de effectiviteit van totaal 886 patiënten (EV+P: N = 442; chemo: N = 444) tussen enfortumab vedotin (Padcev) plus immuuntherapie met pembrolizumab en na een follow-up van 17,2 maanden blijkt de mediane overall overleving zo goed als verdubbelt met 31,5 maanden vs 16,1 maanden. Ook de mediane ziekteprogressie vrije tijd verdubbelde van 6,5 naar 12,3 maanden. Wat vertaald wordt door de onderzoekers van 55 procent minder kans op overlijden aan de ziekte.
De bevestigde onafhankelijk vastgestelde complete en gedeeltelijke remissies (ORR) waren respectievelijk 67,7% in de Enfortumab vedotin + Pembrolizumab groep en 44,4% in de chemogroepen (P<0,00001).
Optredende bijwerkingen:
- Bijwerkingen van graad ≥3 kwamen voor bij 55,9% van de patiënten die met enfortumab vedotin (Padcev) plus immuuntherapie met pembrolizumab waren behandeld en 69,5% bij patiënten die met chemo waren behandeld;
- De meest voorkomende bijwerkingen waren maculopapulaire huiduitslag (7,7%), hyperglykemie (5,0%) en neutropenie (4,8%) voor EV+P en anemie (31,4%), neutropenie (30,0%) en trombocytopenie (19,4%) voor chemotherapie.
- De meest voorkomende (≥5%) bijwerkingen van graad ≥3 die van bijzonder belang zijn voor enfortumab vedotin (Padcev) omvatten huidreacties (15,5%), perifere neuropathie (6,8%) en hyperglykemie (6,1%).
- De meest voorkomende (≥5%) graad ≥3 tijdens de behandeling optredende bijwerkingen die van bijzonder belang zijn voor pembrolizumab waren ernstige huidreacties (11,8%).
Volgens Michiel van der Heijden Medisch Oncoloog in het Anthonie van Leeuwenhoek ziekenhuis en een van de mede onderzoekers van deze studie zal deze behandeling de behandeling van blaaskanker behoorlijk veranderen.
De behandeling met enfortumab vedotin (Padcev) plus immuuntherapie met pembrolizumab moet nog worden geregistreerd en goedgekeurd in Nederland voor vergoeding door de zorgverzekering. Dat kan nog wel een jaar duren. In de VS is Enfortumab Vedotin + pembrolizumab al wel beschikbaar voor een deel van de blaaskankerpatiënten, gebaseerd op een fase-2 studie.
Het volledige studie studierapport is gepubliceerd in Annals of Oncology en gepresenteerd op ESMO 2023.
Background
Platinum-based chemo is the standard of care (SOC) for la/mUC. An unmet need remains as long-term outcomes are poor. Here we present EV-302, a global, phase 3, open-label, randomized study evaluating EV+P in patients (pts) with previously untreated la/mUC who were eligible for cisplatin- or carboplatin-containing chemo.
Methods
Pts with previously untreated la/mUC (regardless of PD-L1 expression) were randomized 1:1 to receive 3-week cycles of EV (1.25 mg/kg; IV) on Days 1 and 8 and P (200 mg; IV) on Day 1 or gemcitabine with cisplatin or carboplatin. Dual primary endpoints were PFS per RECIST v1.1 by BICR and OS. Select secondary endpoints included overall response rate (ORR) and safety.
Results
886 pts (EV+P: 442; chemo: 444) were randomized; pt characteristics were balanced between arms. At data cutoff, median follow-up was 17.2 mo. PFS was significantly prolonged with EV+P vs chemo, reducing the risk of progression or death by 55% (median PFS, 12.5 mo vs 6.3 mo, respectively; HR 0.45 [95% CI: 0.38-0.54]; P<0.00001). OS was significantly prolonged with EV+P vs chemo, reducing the risk of death by 53% (median OS, 31.5 mo vs 16.1 mo, respectively; HR 0.47 [95% CI: 0.38-0.58]; P<0.00001). Confirmed ORR was 67.7% and 44.4% in the EV+P and chemo arms, respectively (P<0.00001). Grade ≥3 TRAEs occurred in 55.9% with EV+P and 69.5% with chemo; most common were maculopapular rash (7.7%), hyperglycemia (5.0%), and neutropenia (4.8%) for EV+P and anemia (31.4%), neutropenia (30.0%), and thrombocytopenia (19.4%) for chemo. Most common (≥5% ) grade ≥3 TRAEs of special interest for EV included skin reactions (15.5%), peripheral neuropathy (6.8%), and hyperglycemia (6.1%). Most common (≥5% ) grade ≥3 treatment-emergent AEs of special interest for P included severe skin reactions (11.8%).
Conclusions
EV+P significantly improved outcomes in pts with previously untreated la/mUC, nearly doubling the median PFS and OS vs chemo. The safety profile was generally manageable with no new safety signals. These results support EV+P as a new SOC for 1L la/mUC.
Clinical trial identification
NCT04223856.
Editorial acknowledgement
Medical writing support was provided by Thien Nguyen, Pharm D. (Seagen Inc.) and Sarah Canestaro, MS, of Populus Group, Troy, MI, supported by Seagen Inc.
Legal entity responsible for the study
Astellas Pharma.
Funding
Funded by Seagen Inc., Bothell, WA, USA; Astellas Pharma, Northbrook, IL, USA; Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA.
Disclosure
T.B. Powles: Financial Interests, Personal, Advisory Board: AstraZeneca, Bristol Myers-Squibb, Exelixis, Incyte, Ipsen, Merck, Novartis, Pfizer, Seattle Genetics, Merck Serono, Astellas, Johnson & Johnson, Eisai, Roche, MSD; Financial Interests, Personal, Other, Travel/Accommodation/Expenses: Roche, Pfizer, MSD, AstraZeneca, Ipsen; Financial Interests, Personal, Other, Sponsorship for Uromigos Podcast: Mashup Ltd; Financial Interests, Institutional, Research Grant: AstraZeneca, Roche, Bristol Myers-Squibb, Exelixis, Ipsen, Merck, MSD, Seattle Genetics, Novartis, Pfizer, Merck Serono, Astellas, Johnson & Johnson, Eisai. B. Perez Valderrama: Financial Interests, Personal, Advisory Board: Pfizer, Astellas Pharma, Bristol-Myers Squibb, Ipsen, EUSA Pharma, Merck, MSD, AstraZeneca, AAA; Financial Interests, Personal, Invited Speaker: Bristol-Myers Squibb, Roche, Bayer, EUSA Pharma, MSD, Merck, Pfizer, Janssen, Astellas Pharma, AAA. S. Gupta: Financial Interests, Personal, Advisory Board: Seattle Genetics, BMS, Pfizer, Bayer, Merck, Gilead, Loxo Oncology, Guardant, Foundation one; Financial Interests, Personal, Other, Speaker's Bureau: Janssen; Financial Interests, Personal, Other, Consultant: EMD Sorono; Financial Interests, Personal, Invited Speaker: Gilead; Financial Interests, Personal, Stocks/Shares: BioNTech, Moderna; Financial Interests, Personal, Steering Committee Member: BMS, Merck, Seattle Genetics, Acrivon; Financial Interests, Institutional, Local PI: EMD Serono, Gilead, Roche, QED, Exelixis, Moderna. J. Bedke: Financial Interests, Personal, Advisory Board: AstraZeneca, Astellas, Eisai; Financial Interests, Personal, Advisory Board and Speaker´s Bureau: BMS, Ipsen, MSD, Merck Serono, Pfizer, Roche, Janssen; Financial Interests, Institutional, Advisory Board: BMS, Pfizer; Financial Interests, Institutional, Local PI: AstraZeneca, Eisai, Novartis, Nektar; Financial Interests, Institutional, Invited Speaker: Astellas, BMS, MSD, Ipsen, Pfizer, Roche, Seagen; Other, Member of the Renal Cell Carcinoma Guidelines Panel: European Association of Urology. E. Kikuchi: Financial Interests, Personal, Invited Speaker: MSD, Bristol, Janssen, Astellas, Merck Biopham, Nippon Kayaku, Pfizer; Financial Interests, Personal, Advisory Board: Astellas, MSD, Bristol; Financial Interests, Institutional, Research Grant: Takeda, Nippon Kayaku, Kyorin, Taiho, Nippon Shinyaku. C. Vulsteke: Financial Interests, Personal, Advisory Board: MSD, Janssen-Cilag, GSK, Astellas Pharma, BMS, Leo Pharma, Bayer, AstraZeneca, Pfizer, Merck; Financial Interests, Institutional, Research Grant, Funding for research project on immune related toxicities: MSD. D.E. Castellano Gauna: Financial Interests, Personal, Advisory Board: Pfizer, Roche, BMS, Janssen, Astellas, MSD, Ipsen, AstraZeneca, Novartis, GSK; Financial Interests, Institutional, Local PI: Pfizer, Roche, MSD, BMS, AstraZeneca, Janssen, Astellas, Ipsen, Exelisis, Eisai, Lilly, Bayer, GSK, Clovis, QED Therapeutics; Non-Financial Interests, Personal, Other, Executive member: SOGUG (Spanish Oncology Genito-Urinary Group) Foundation. J. Li: Financial Interests, Personal, Invited Speaker: Astellas, Janssen Pharma, Bayer Pharmaceuticals, AstraZeneca, Ono Pharmaceutical, Merck, MSD, Roche, Synmosa, Pfizer, COOK. M. Gumus: Financial Interests, Institutional, Invited Speaker: Pfizer, Gen Pharmaceuticals, Novartis, Bayer, Amgen; Financial Interests, Institutional, Advisory Board: Amgen, Roche, BMS, AstraZeneca; Financial Interests, Institutional, Local PI: Jounce Therapeutics. N. Mar: Financial Interests, Personal, Invited Speaker: Eisai, Aveo, Tempus, Seattle Genetics; Financial Interests, Personal and Institutional, Funding, Funding for investigator initiated trial: Gilead. S. Narayanan: Financial Interests, Institutional, Full or part-time Employment: Seagen Inc; Financial Interests, Institutional, Stocks/Shares: Seagen Inc. X. Yu: Financial Interests, , Full or part-time Employment: Seagen; Financial Interests, Stocks/Shares: Seagen. S. Gorla: Financial Interests, Personal, Full or part-time Employment, I have been a full time employee of Astellas since 2012 and part of my role involves review of publications and other documents regarding the clinical trials we have conducted involving our products: Astellas; Non-Financial Interests, Project Lead, I have been a full time employee of Astellas since 2012 and have a leadership role in the projects that I lead: Astellas; Non-Financial Interests, Personal, Proprietary Information, I have been a full time employee of Astellas since 2012 and therefore have access to company confidential information about our products: Astellas. B. Homet Moreno: Financial Interests, Full or part-time Employment: Merck; Financial Interests, Proprietary Information: Merck. M.S. van der Heijden: Financial Interests, Institutional, Advisory Board: AstraZeneca, BMS, Janssen, MSD, Seagen, Pfizer; Financial Interests, Institutional, Funding, Investigator-initiated trial: BMS, Roche, AstraZeneca, 4SC; Financial Interests, Institutional, Invited Speaker, Local PI + SSC member: BMS, AstraZeneca, MSD, Seagen; Financial Interests, Institutional, Invited Speaker, Local PI + study co-PI: Janssen; Financial Interests, Institutional, Local PI: GSK. All other authors have declared no conflicts of interest.
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© 2023 European Society for Medical Oncology. Published by Elsevier Inc. All rights reserved.
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