Wei-Sen Lam1, Jenette Creaney2, Fred K Chen3, Wee Loong Chin4, Sanjeevan Muruganandan5, Sukanya Arunachalam6, Mary S Attia7, Catherine Read8, Kevin Murray9, Michael Millward10, Jon Spiro11, Aron Chakera12, Y C Gary Lee13, Anna K Nowak14. 1. Department of Medical Oncology, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, 6009, Australia; National Centre for Asbestos Related Diseases, University of Western Australia, Level 5, QQ Block, QEII Medical Centre, Western Australia, 6009, Australia. Electronic address: wei-Sen.lam@health.wa.gov.au. 2. National Centre for Asbestos Related Diseases, University of Western Australia, Level 5, QQ Block, QEII Medical Centre, Western Australia, 6009, Australia; Institute for Respiratory Health, University of Western Australia, Sir Charles Gairdner Hospital Avenue, Nedlands, Western Australia, 6009, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, 6009, Australia. Electronic address: jenette.creaney@uwa.edu.au. 3. Centre for Ophthalmology and Visual Science (incorporating Lions Eye institute), The University of Western Australia, Nedlands, Western Australia, 6009, Australia. Electronic address: fredchen@lei.org.au. 4. Department of Medical Oncology, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, 6009, Australia; National Centre for Asbestos Related Diseases, University of Western Australia, Level 5, QQ Block, QEII Medical Centre, Western Australia, 6009, Australia; School of Biomedical Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, 6009, Australia; Medical School, University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, 6009, Australia. Electronic address: wee.chin@health.wa.gov.au. 5. Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, 6009, Australia. Electronic address: sanjeevan.muruganandan@nh.org.au. 6. Centre for Ophthalmology and Visual Science (incorporating Lions Eye institute), The University of Western Australia, Nedlands, Western Australia, 6009, Australia. Electronic address: sukanyaprakkash@gmail.com. 7. Centre for Ophthalmology and Visual Science (incorporating Lions Eye institute), The University of Western Australia, Nedlands, Western Australia, 6009, Australia. Electronic address: marie.safwat1@gmail.com. 8. Institute for Respiratory Health, University of Western Australia, Sir Charles Gairdner Hospital Avenue, Nedlands, Western Australia, 6009, Australia. Electronic address: cathy.read@health.wa.gov.au. 9. School of Population and Global Health, University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, 6009, Australia. Electronic address: kevin.murray@uwa.edu.au. 10. Department of Medical Oncology, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, 6009, Australia; Medical School, University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, 6009, Australia. Electronic address: michael.millward@health.wa.gov.au. 11. Department of Cardiology, Royal Perth Hospital, Wellington Street, Perth, Western Australia, 6000, Australia. Electronic address: jon.spiro@health.wa.gov.au. 12. Renal Unit, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, 6009, Australia. Electronic address: aron.chakera@health.wa.gov.au. 13. Institute for Respiratory Health, University of Western Australia, Sir Charles Gairdner Hospital Avenue, Nedlands, Western Australia, 6009, Australia; Medical School, University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, 6009, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, 6009, Australia. Electronic address: gary.lee@uwa.edu.au. 14. Department of Medical Oncology, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, 6009, Australia; National Centre for Asbestos Related Diseases, University of Western Australia, Level 5, QQ Block, QEII Medical Centre, Western Australia, 6009, Australia; Institute for Respiratory Health, University of Western Australia, Sir Charles Gairdner Hospital Avenue, Nedlands, Western Australia, 6009, Australia; Medical School, University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, 6009, Australia. Electronic address: anna.nowak@uwa.edu.au.
Abstract
OBJECTIVES: Currently, there is no optimal salvage therapy for patients with malignant pleural mesothelioma (MPM) who relapse after treatment with first-line chemotherapy. In line with the strong preclinical rationale for targeting fibroblast growth factor receptor (FGFR) signalling in malignant mesothelioma, we conducted a phase II study assessing the efficacy of AZD4547, an oral tyrosine multi-kinase FGFR 1-3 inhibitor, as a second or third-line treatment. MATERIALS AND METHODS: We conducted a single-center, open-label, single-arm phase II study of AZD4547 in eligible patients with confirmed, measurable MPM and radiological progression after first or second-line systemic chemotherapy. Patients received continuous, twice-daily oral AZD4547 on a 3-weekly cycle. The primary end point was 6-month progression free survival (PFS6). Response was assessed with CT scan every 6 weeks according to the modified RECIST criteria for mesothelioma (mRECIST) and toxicities were also assessed. The study used a Simon's two-stage design: 26 patients would be recruited to the first stage and more than 7 (27 %) of 26 patients were required to achieve PFS6 to continue to stage two, for a potential total cohort of 55 patients. RESULTS: 3 of 24 patients (12 %) were progression-free at 6 months. Hence, the study fulfilled stopping criteria regardless of further recruitment and warranted discontinuation. The most common toxicities (across all grades) were hyperphosphatemia, xerostomia, mucositis, retinopathy, dysgeusia, and fatigue. Maximum toxicities were grade 2 or below for all patients across all cycles. There was no association between tumour BAP1 protein loss and clinical outcomes. CONCLUSIONS: The FGFR 1-3 inhibitor AZD4547 did not demonstrate efficacy in patients with MPM who had progressed after first line treatment with platinum-based chemotherapy.
OBJECTIVES: Currently, there is no optimal salvage therapy for patients with malignant pleural mesothelioma (MPM) who relapse after treatment with first-line chemotherapy. In line with the strong preclinical rationale for targeting fibroblast growth factor receptor (FGFR) signalling in malignant mesothelioma, we conducted a phase II study assessing the efficacy of AZD4547, an oral tyrosine multi-kinase FGFR 1-3 inhibitor, as a second or third-line treatment. MATERIALS AND METHODS: We conducted a single-center, open-label, single-arm phase II study of AZD4547 in eligible patients with confirmed, measurable MPM and radiological progression after first or second-line systemic chemotherapy. Patients received continuous, twice-daily oral AZD4547 on a 3-weekly cycle. The primary end point was 6-month progression free survival (PFS6). Response was assessed with CT scan every 6 weeks according to the modified RECIST criteria for mesothelioma (mRECIST) and toxicities were also assessed. The study used a Simon's two-stage design: 26 patients would be recruited to the first stage and more than 7 (27 %) of 26 patients were required to achieve PFS6 to continue to stage two, for a potential total cohort of 55 patients. RESULTS: 3 of 24 patients (12 %) were progression-free at 6 months. Hence, the study fulfilled stopping criteria regardless of further recruitment and warranted discontinuation. The most common toxicities (across all grades) were hyperphosphatemia, xerostomia, mucositis, retinopathy, dysgeusia, and fatigue. Maximum toxicities were grade 2 or below for all patients across all cycles. There was no association between tumourBAP1protein loss and clinical outcomes. CONCLUSIONS: The FGFR 1-3 inhibitor AZD4547 did not demonstrate efficacy in patients with MPM who had progressed after first line treatment with platinum-based chemotherapy.