D Ferraro1,2, D Goldstein3, R L O'Connell1, J R Zalcberg4, K M Sjoquist1, N C Tebbutt5, P Grimison6, S McLachlan7,8, L L Lipton9, P Vasey10, V J Gebski1, C Aiken1, M Cronk11, S Ng12, C S Karapetis13, J Shannon14. 1. National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia. 2. Department of Pathology, University of Melbourne, Parkville, VIC, Australia. 3. Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia. 4. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. 5. Austin Health, Melbourne, VIC, Australia. 6. Chris O'Brien Lifehouse, Sydney, NSW, Australia. 7. St Vincents Hospital, Melbourne, VIC, Australia. 8. University of Melbourne, Melbourne, VIC, Australia. 9. Western Health, Melbourne, VIC, Australia. 10. Haematology and Oncology Clinics of Australasia, Wesley Medical Centre, Brisbane, QLD, Australia. 11. Nambour General Hospital, Nambour, QLD, Australia. 12. Sir Charles Gairdner Hospital, Nedlands, WA, Australia. 13. Flinders University, Adelaide, SA, Australia. 14. Department of Medical Oncology, Nepean Cancer Care Centre, PO Box 63, Penrith, Sydney, NSW, 2751, Australia. Jenny.Shannon@health.nsw.gov.au.
Abstract
PURPOSE: The phase II TACTIC trial prospectively selected patients with KRAS wild-type advanced biliary tract cancer for first-line treatment with panitumumab and combination chemotherapy. METHODS: Of 78 patients screened, 85 % had KRAS wild-type tumours and 48 were enrolled. Participants received cisplatin 25 mg/m(2) and gemcitabine 1000 mg/m(2) on day 1 and day 8 of each 21-day cycle and panitumumab 9 mg/kg on day 1 of each cycle. Treatment was continued until disease progression, unacceptable toxicity, or request to discontinue. The primary endpoint was the clinical benefit rate (CBR) at 12 weeks (complete response, partial response, or stable disease). CBR of 70 % was considered to be of clinical interest. Secondary outcomes were progression-free survival, time to treatment failure, overall survival, CA19.9 response and safety. RESULTS: Thirty-four patients had a clinical benefit at 12 weeks, an actuarial rate of 80 % (95 % CI 65-89 %). 46 % had a complete or partial response. Median progression-free survival was 8.0 months (95 % CI 5.1-9.9) and median overall survival 11.9 months (95 % CI 7.4-15.8). Infection accounted for 27 % of the grade 3 or 4 toxicity, with rash (13 %), fatigue (13 %), and hypomagnesemia (10 %) among the more common grade 3 or 4 non-haematological toxicities. CONCLUSION: A marker-driven approach to patient selection was feasible in advanced biliary tract cancer in an Australian population. The combination of panitumumab, gemcitabine, and cisplatin in KRAS wild-type cancers was generally well tolerated and showed promising clinical efficacy. Further exploration of anti-EGFR therapy in a more selected population is warranted.
PURPOSE: The phase II TACTIC trial prospectively selected patients with KRAS wild-type advanced biliary tract cancer for first-line treatment with panitumumab and combination chemotherapy. METHODS: Of 78 patients screened, 85 % had KRAS wild-type tumours and 48 were enrolled. Participants received cisplatin 25 mg/m(2) and gemcitabine 1000 mg/m(2) on day 1 and day 8 of each 21-day cycle and panitumumab 9 mg/kg on day 1 of each cycle. Treatment was continued until disease progression, unacceptable toxicity, or request to discontinue. The primary endpoint was the clinical benefit rate (CBR) at 12 weeks (complete response, partial response, or stable disease). CBR of 70 % was considered to be of clinical interest. Secondary outcomes were progression-free survival, time to treatment failure, overall survival, CA19.9 response and safety. RESULTS: Thirty-four patients had a clinical benefit at 12 weeks, an actuarial rate of 80 % (95 % CI 65-89 %). 46 % had a complete or partial response. Median progression-free survival was 8.0 months (95 % CI 5.1-9.9) and median overall survival 11.9 months (95 % CI 7.4-15.8). Infection accounted for 27 % of the grade 3 or 4 toxicity, with rash (13 %), fatigue (13 %), and hypomagnesemia (10 %) among the more common grade 3 or 4 non-haematological toxicities. CONCLUSION: A marker-driven approach to patient selection was feasible in advanced biliary tract cancer in an Australian population. The combination of panitumumab, gemcitabine, and cisplatin in KRAS wild-type cancers was generally well tolerated and showed promising clinical efficacy. Further exploration of anti-EGFR therapy in a more selected population is warranted.
Entities:
Keywords:
Biliary tract cancer; Cancer antigen 19.9; Chemotherapy; KRAS; Panitumumab; Phase II trial
Authors: Yehuda Z Patt; Waheed Murad; Mohammed H Fekrazad; Ari D Baron; Pranshu Bansal; Yanis Boumber; Kim Steinberg; Sang-Joon Lee; Ed Bedrick; Ruofei Du; Fa Chyi Lee Journal: Cancer Med Date: 2017-08-11 Impact factor: 4.452
Authors: Mairéad Geraldine McNamara; John Bridgewater; Andre Lopes; Harpreet Wasan; David Malka; Lars Henrik Jensen; Takuji Okusaka; Jennifer J Knox; Dorothea Wagner; David Cunningham; Jenny Shannon; David Goldstein; Markus Moehler; Tanios Bekaii-Saab; Juan W Valle Journal: BMC Cancer Date: 2017-04-12 Impact factor: 4.430