16 december 2024: Bron: Clin Cancer Res (2024) 30 (9): 1750–1757.

Uit de fase II LITESPARK-004 studie blijkt dat Belzutifan (merknaam Welireg) een uitstekende behandeling is om bij patiënten met de erfelijke ziekte van von Hippel-Landau te voorkomen dat zij een volledige neuro endocriene vorm van kanker ontwikkelen. Bij de patiënten die aan de LITESPARK-004 studie meededen hadden alle patiënten minstens 1 alvleesklierkankertumor en 22 patiënten (36 procent) van de patiënten hadden reeds een meetbare neuro endocriene tumor (pNET tumor) voordat de studie begon.

Bij 51 van de 61 deelnemende patiënten zorgde Belzutifan (merknaam Welireg) ervoor dat zij een complete remissie bereikten en de tumoren verdwenen. Bij 20 van de 22 patiënten met al een pNET tumor verdwenen ook deze tumoren. Bovendien traden er bij geen van de patiënten ernstige bijwerkingen van graad 4 of 5 op. En slechts 18 procent van de patiënten lieten bijwerkingen zien van graad 3. Die ook goed te behandelen en controleren waren.  

De onderzoekers stellen dat deze resultaten het gebruik van Belzutifan (merknaam Welireg) aantonen voor voorlopers van een pNET tumor waarvoor in feite als standaard behandeling een chirurgische ingreep nodig zou zijn. De resultaten leveren verder bewijs voor de baanbrekende impact op het behandelen van patiënten met de erfelijke ziekte van von Hippel-Landau  en de effecten ervan op niercelkanker en hemangioblastomen van het centrale zenuwstelsel. Aldus de onderzoekers.

Het volledige studierapport is gratis in te zien. Zie ook dit abstract:

Belzutifan for von Hippel–Lindau Disease: Pancreatic Lesion Population of the Phase 2 LITESPARK-004 Study 

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Clin Cancer Res (2024) 30 (9): 1750–1757.

Article history

Purpose:

Primary analysis of the ongoing, single-arm, phase 2 LITESPARK-004 study (NCT03401788) showed clinically meaningful antitumor activity in von Hippel–Lindau (VHL) disease–associated renal cell carcinoma (RCC) and other neoplasms with belzutifan treatment. We describe results of belzutifan treatment for VHL disease–associated pancreatic lesions [pancreatic neuroendocrine tumors (pNET) and serous cystadenomas].

Patients and Methods:

Adults with VHL diagnosis based on germline VHL alteration, ≥1 measurable RCC tumor, no renal tumor >3 cm or other VHL neoplasm requiring immediate surgery, Eastern Cooperative Oncology Group performance status of 0 or 1, and no prior systemic anticancer treatment received belzutifan 120 mg once daily. End points included objective response rate (ORR), duration of response (DOR), progression-free survival (PFS), and linear growth rate (LGR) in all pancreatic lesions and pNETs per RECIST version 1.1 by independent review committee, and safety.

Results:

All 61 enrolled patients (100%) had ≥1 pancreatic lesion and 22 (36%) had ≥1 pNET measurable at baseline. Median follow-up was 37.8 months (range, 36.1–46.1). ORR was 84% [51/61; 17 complete responses (CR)] in pancreatic lesions and 91% (20/22; 7 CRs) in pNETs. Median DOR and median PFS were not reached in pancreatic lesions or pNETs. After starting treatment, median LGR for pNETs was –4.2 mm per year (range, –7.9 to –0.8). Eleven patients (18%) had ≥1 grade 3 treatment-related adverse event (AE). No grade 4 or 5 treatment-related AEs occurred.

Conclusions:

Belzutifan continued to show robust activity and manageable safety in VHL disease–associated pNETs.

This article is featured in Highlights of This Issue, p. 1703

Translational Relevance

Management for patients with von Hippel–Lindau (VHL) disease includes observation followed by surgery. Hypoxia-inducible factor 2α (HIF-2α) plays an important role in manifestations of VHL disease, including clear cell renal cell carcinoma, central nervous system hemangioblastomas, and pancreatic neuroendocrine tumors (pNET), by inactivating the VHL gene and inducing upregulation of genes associated with cancer growth and survival. Most patients with VHL disease will develop pancreatic lesions and require multiple surgeries throughout their lifetime. Results of the phase 2 LITESPARK-004 trial demonstrated that treatment with the first-in-class HIF-2α inhibitor belzutifan had durable antitumor activity in VHL-associated pancreatic lesions, which included both pNETs and serous cystadenomas. Changes in growth rate after initiating belzutifan treatment indicate changes in tumor behavior and may indicate longer time to surgical intervention. No patients underwent a pancreas-related surgery after starting belzutifan treatment. Results from this trial further support the use of belzutifan in this patient population.

T. Else reports support from MSD during the conduct of the study, as well as personal fees from MSD, Lantheus, and HRA Pharma outside the submitted work. E. Jonasch reports grants from MSD during the conduct of the study. E. Jonasch also reports grants from Aveo, Arrowhead, Corvus, MSD, NiKang, and Telix, as well as honoraria from Aveo, DAVA, Eisai, Exelixis, Ipsen, MSD, NiKang, and Novartis outside the submitted work. O. lliopoulos received consultancy fees from Merck. K.E. Beckermann reports support from MSD during the conduct of the study. K.E. Beckermann also reports grants from BMS-LCFA-IASLC, Arsenal Biosciences, Pionyr, Aravive, and the US Department of Defense, as well as consulting fees from Aravive, Aveo, Alpine Bioscience, BMS, Exelixis, Merck, Nimbus, Arcus, Xencor, Sanofi, AstraZeneca, and Seagen. V. Narayan reports grants from Merck during the conduct of the study. V. Narayan also reports consulting fees from AstraZeneca, Exelixis, Janssen, Merck & Co., Inc., Myovant Sciences, Pfizer Regeneron, and Sanofi, as well as research support (to institution) from Bristol Myers Squibb, Janssen, Merck & Co., Inc., Pfizer, Regeneron, and TMunity Therapeutics outside the submitted work. B.L. Maughan reports personal fees from AbbVie, Pfizer, Aveo Oncology, Janssen, Astellas, Tempus, MSD, Bayer Oncology, Lilly, Sanofi, Telix, and Peloton Therapeutics; grants and personal fees from Bristol Myers Squibb, Clovis, and Exelixis; and grants from Bavarian-Nordic and Genentech during the conduct of the study. B.L Maughan also reports working for Xencor as a consultant/advisor. S. Oudard reports honoraria from Astellas, Bayer, Bristol Myers Squibb, Eisai, Ipsen, Janssen, MSD, Novartis, Pfizer, Roche/Genentech, and Sanofi; consulting to Astellas, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Eisai, Ipsen, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi, and SD Oncology; research funding from Ipsen and Sanofi; and travel, accommodation, and expense reimbursements from Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Eisai, MSD, Novartis, and Roche. J.K. Maranchie reports personal fees from Elsevier; grants from NCI; and other support from Janssen, LUGPA, and MSD during the conduct of the study. J.K. Maranchie also reports other support from SUO outside the submitted work. C.M. Goldberg is an employee of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc. and has stock ownership in Merck & Co. W. Fu is an employee of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc. R.F. Perini is an employee of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., and has stock ownership in Merck & Co., Inc. Y. Liu is an employee of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc. R. Srinivasan reports research funding (to institution) from MSD during the conduct of the study. No disclosures were reported by the other authors.

T. Else: Investigation, writing–review and editing. E. Jonasch: Conceptualization, writing–review and editing. O. lliopoulos: Conceptualization, resources, investigation, writing–review and editing. K.E. Beckermann: Resources, data curation, investigation, writing–review and editing. V. Narayan: Formal analysis, investigation, writing–review and editing. B.L. Maughan: Resources, data curation, investigation, writing–review and editing. S. Oudard: Formal analysis, investigation, writing–review and editing. J.K. Maranchie: Investigation, writing–review and editing. A.B. Iversen: Validation, investigation, writing–review and editing. C.M. Goldberg: Investigation, writing–review and editing. W. Fu: Conceptualization, formal analysis, investigation, writing–review and editing. R.F. Perini: Formal analysis, validation, investigation, writing–review and editing. Y. Liu: Investigation, writing–review and editing. W.M. Linehan: Conceptualization, investigation, writing–review and editing. R. Srinivasan: Conceptualization, resources, formal analysis, supervision, funding acquisition, validation, investigation, writing–review and editing.

We thank the patients and their families and caregivers for participating in the study. Medical writing and/or editorial assistance was provided by Mallory Campbell, PhD, and Robert Steger, PhD, of ApotheCom. This assistance was funded by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc. Funding for this research was provided by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc. and the Intramural Research Program of the National Institutes of Health, National Cancer Institute (NCI) Center for Cancer Research, and a grant (UO1 CA236489) from the NCI.

Note: Supplementary data for this article are available at Clinical Cancer Research Online (http://clincancerres.aacrjournals.org/).

1.
 
Chittiboina
 
P
 , 
Lonser
 
RR
 . 
Von Hippel–Lindau disease
. 
Handb Clin Neurol
 
2015
;
132
:
139
–
56
.
2.
 
Haase
 
VH
 . 
The VHL tumor suppressor: master regulator of HIF
. 
Curr Pharm Des
 
2009
;
15
:
3895
–
903
.
3.
 
van Asselt
 
SJ
 , 
de Vries
 
EG
 , 
van Dullemen
 
HM
 , 
Brouwers
 
AH
 , 
Walenkamp
 
AM
 , 
Giles
 
RH
 , et al . 
Pancreatic cyst development: insights from von Hippel–Lindau disease
. 
Cilia
 
2013
;
2
:
3
.
4.
 
Ganeshan
 
D
 , 
Menias
 
CO
 , 
Pickhardt
 
PJ
 , 
Sandrasegaran
 
K
 , 
Lubner
 
MG
 , 
Ramalingam
 
P
 , et al . 
Tumors in von Hippel–Lindau syndrome: from head to toe-comprehensive state-of-the-art review
. 
Radiographics
 
2018
;
38
:
849
–
66
.
5.
 
Choueiri
 
TK
 , 
Kaelin
 
WG
 . 
Targeting the HIF2–VEGF axis in renal cell carcinoma
. 
Nat Med
 
2020
;
26
:
1519
–
30
.
6.
 
Maher
 
ER
 , 
Neumann
 
HP
 , 
Richard
 
S
 . 
von Hippel–Lindau disease: a clinical and scientific review
. 
Eur J Hum Genet
 
2011
;
19
:
617
–
23
.
7.
 
Schuhmacher
 
P
 , 
Kim
 
E
 , 
Hahn
 
F
 , 
Sekula
 
P
 , 
Jilg
 
CA
 , 
Leiber
 
C
 , et al . 
Growth characteristics and therapeutic decision markers in von Hippel–Lindau disease patients with renal cell carcinoma
. 
Orphanet J Rare Dis
 
2019
;
14
:
235
.
8.
 
Couch
 
V
 , 
Lindor
 
NM
 , 
Karnes
 
PS
 , 
Michels
 
VV
 . 
von Hippel–Lindau disease
. 
Mayo Clin Proc
 
2000
;
75
:
265
–
72
.
9.
 
Flores-Martínez
 
A
 , 
García-Núñez
 
A
 , 
Rojas
 
A
 , 
Cano
 
DA
 . 
Stabilization of HIF-2α impacts pancreas growth
. 
Sci Rep
 
2018
;
8
:
13713
.
10.
 
Keutgen
 
XM
 , 
Hammel
 
P
 , 
Choyke
 
PL
 , 
Libutti
 
SK
 , 
Jonasch
 
E
 , 
Kebebew
 
E
 . 
Evaluation and management of pancreatic lesions in patients with von Hippel–Lindau disease
. 
Nat Rev Clin Oncol
 
2016
;
13
:
537
–
49
.
11.
 
Hammel
 
PR
 , 
Vilgrain
 
V
 , 
Terris
 
B
 , 
Penfornis
 
A
 , 
Sauvanet
 
A
 , 
Correas
 
JM
 , et al . 
Pancreatic involvement in von Hippel–Lindau disease. The groupe francophone d'etude de la maladie de von Hippel–Lindau
. 
Gastroenterology
 
2000
;
119
:
1087
–
95
.
12.
 
Tirosh
 
A
 , 
Sadowski
 
SM
 , 
Linehan
 
WM
 , 
Libutti
 
SK
 , 
Patel
 
D
 , 
Nilubol
 
N
 , et al . 
Association of VHL genotype with pancreatic neuroendocrine tumor phenotype in patients with von Hippel–Lindau disease
. 
JAMA Oncol
 
2018
;
4
:
124
–
6
.
13.
 
Zwolak
 
A
 , 
Świrska
 
J
 , 
Tywanek
 
E
 , 
Dudzińska
 
M
 , 
Tarach
 
JS
 , 
Matyjaszek-Matuszek
 
B
 . 
Pancreatic neuroendocrine tumours in patients with von Hippel–Lindau disease
. 
Endokrynol Pol
 
2020
;
71
:
256
–
9
.
14.
 
Ayloo
 
S
 , 
Molinari
 
M
 . 
Pancreatic manifestations in von Hippel–Lindau disease: a case report
. 
Int J Surg Case Rep
 
2016
;
21
:
70
–
2
.
15.
 
Ahmad
 
S
 , 
Naber
 
MR
 , 
Giles
 
RH
 , 
Valk
 
GD
 , 
van Leeuwaarde
 
RS
 . 
Diagnostic and management strategies for pNETs in von Hippel–Lindau: a systematic review
. 
Endocr Relat Cancer
 
2021
;
28
:
151
–
60
.
16.
 
Krauss
 
T
 , 
Ferrara
 
AM
 , 
Links
 
TP
 , 
Wellner
 
U
 , 
Bancos
 
I
 , 
Kvachenyuk
 
A
 , et al . 
Preventive medicine of von Hippel–Lindau disease-associated pancreatic neuroendocrine tumors
. 
Endocr Relat Cancer
 
2018
;
25
:
783
–
93
.
17.
 
Laks
 
S
 , 
van Leeuwaarde
 
R
 , 
Patel
 
D
 , 
Keutgen
 
XM
 , 
Hammel
 
P
 , 
Nilubol
 
N
 , et al . 
Management recommendations for pancreatic manifestations of von Hippel–Lindau disease
. 
Cancer
 
2022
;
128
:
435
–
46
.
18.
 
Blansfield
 
JA
 , 
Choyke
 
L
 , 
Morita
 
SY
 , 
Choyke
 
PL
 , 
Pingpank
 
JF
 , 
Alexander
 
HR
 , et al . 
Clinical, genetic and radiographic analysis of 108 patients with von Hippel–Lindau disease (VHL) manifested by pancreatic neuroendocrine neoplasms (PNETs)
. 
Surgery
 
2007
;
142
:
814
–
8
.
19.
 
Kanthan
 
R
 , 
Senger
 
J
 , 
Ahmed
 
S
 , 
Kanthan
 
S
 . 
Pancreatic neuroendocrine tumors in the 21st century—an update
. 
J Can Ther
 
2017
;
8
:
1194
–
233
.
20.
 
Blumenthal
 
GM
 , 
Cortazar
 
P
 , 
Zhang
 
JJ
 , 
Tang
 
S
 , 
Sridhara
 
R
 , 
Murgo
 
A
 , et al . 
FDA approval summary: sunitinib for the treatment of progressive well-differentiated locally advanced or metastatic pancreatic neuroendocrine tumors
. 
Oncologist
 
2012
;
17
:
1108
–
13
.
21.
 
Megdanova-Chipeva
 
VG
 , 
Lamarca
 
A
 , 
Backen
 
A
 , 
McNamara
 
MG
 , 
Barriuso
 
J
 , 
Sergieva
 
S
 , et al . 
Systemic treatment selection for patients with advanced pancreatic neuroendocrine tumours (PanNETs)
. 
Cancers
 
2020
;
12
:
1988
.
22.
 
WELIREG (belzutifan) tablets, for oral use. 05/2022
. 
Merck & Co., Inc.
, 
Rahway, NJ
; 
2022
. 
Available from:
 https://www.merck.com/product/usa/pi_circulars/w/welireg/welireg_pi.pdf.
23.
 
Jonasch
 
E
 , 
Donskov
 
F
 , 
Iliopoulos
 
O
 , 
Rathmell
 
WK
 , 
Narayan
 
VK
 , 
Maughan
 
BL
 , et al . 
Belzutifan for renal cell carcinoma in von Hippel–Lindau disease
. 
N Engl J Med
 
2021
;
385
:
2036
–
46
.
24.
Medicines and Healthcare products Regulatory Agency (MHRA)
. 
First Innovation Passport awarded to help support development and access to cutting-edge medicines
. 
London, UK
: 
MHRA
; 
2022
. 
Available from
: https://www.gov.uk/government/news/first-innovation-passport-awarded-to-help-support-development-and-access-to-cutting-edge-medicines.
25.
Commonwealth of Australia
. 
Welireg Australian Therapeutic Goods Administration approval
. In 
Commonwealth of Australia. MSD (Australia) Pty Limited
 
2023. Available from:
 https://www.tga.gov.au/resources/auspmd/welireg.
26.
 
WELIREG belzutifan tablets, 40 mg, oral
. 
(Monograph). 07/11/2022
. 
Merck Canada Inc.
: 
Kirkland QC Canada
; 
2022
. p. 
26
.
27.
 
Li
 
Z
 , 
Zhang
 
J
 , 
Zhang
 
L
 , 
Yao
 
L
 , 
Zhang
 
C
 , 
He
 
Z
 , et al . 
Natural history and growth kinetics of clear cell renal cell carcinoma in sporadic and von Hippel–Lindau disease
. 
Transl Androl Urol
 
2021
;
10
:
1064
.
28.
 
Weisbrod
 
AB
 , 
Kitano
 
M
 , 
Thomas
 
F
 , 
Williams
 
D
 , 
Gulati
 
N
 , 
Gesuwan
 
K
 , et al . 
Assessment of tumor growth in pancreatic neuroendocrine tumors in von Hippel–Lindau syndrome
. 
J Am Coll Surg
 
2014
;
218
:
163
–
9
.
29.
 
Ma
 
K
 , 
Hong
 
B
 , 
Zhou
 
J
 , 
Gong
 
Y
 , 
Wang
 
J
 , 
Liu
 
S
 , et al . 
The efficacy and safety of tyrosine kinase inhibitors for von Hippel–Lindau disease: a retrospective study of 32 patients
. 
Front Oncol
 
2019
;
9
:
1122
.
30.
 
Jonasch
 
E
 , 
McCutcheon
 
IE
 , 
Waguespack
 
SG
 , 
Wen
 
S
 , 
Davis
 
DW
 , 
Smith
 
LA
 , et al . 
Pilot trial of sunitinib therapy in patients with von Hippel–Lindau disease
. 
Ann Oncol
 
2011
;
22
:
2661
–
6
.
31.
 
Jonasch
 
E
 , 
McCutcheon
 
IE
 , 
Gombos
 
DS
 , 
Ahrar
 
K
 , 
Perrier
 
ND
 , 
Liu
 
D
 , et al . 
Pazopanib in patients with von Hippel–Lindau disease: a single-arm, single-centre, phase 2 trial
. 
Lancet Oncol
 
2018
;
19
:
1351
–
9
.
This open access article is distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license.

Supplementary data

Data from Belzutifan for von Hippel–Lindau Disease: Pancreatic Lesion Population of the Phase 2 LITESPARK-004 Study

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Supplementary
Table
3. Treatment
-related
adverse
event
summary.
All
patients
N
= 61
Any
-
grade
AE
61
(100)
Any
-
grade
treatment
-
related
AE
61
(100)
Grade
3
-
5
AE
27
(44)
Grade
3
treatment
-
related
AE
11
(18)
Dose
interruption
because
of
a
treatment
-
related
AE
13
(21)
Dose
reduction
because
of
a
treatment
-
related
AE
8
(13)
Treatment
discontinuation
because
of
a
treatment
-
related AE
2
(3)
Death
because
of
a
treatment
-
related
AE
0
(0)
Values are n (%).
AE,
adverse
event.





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