The purpose of this study was to evaluate the efficacy of derazantinib monotherapy or derazantinib in combination with paclitaxel and ramucirumab in patients with gastric adenocarcinoma (GAC) i.e. with human epidermal growth factor receptor 2 (HER2)-negative adenocarcinoma of the stomach or gastro-esophageal junction harboring fibroblast growth factor receptor 2 (FGFR2) genetic aberrations (GA).
The study comprised two open-label substudies in patients with HER2-negative adenocarcinoma of the stomach or gastro-esophageal junction harboring FGFR2 gene translocations, FGFR2 gene amplifications, or FGFR1-3 mutations. In Substudy 1, GAC patients with specified FGFR GAs, after either first- or second-line treatment, and no approved treatment alternative were treated with derazantinib 300 mg once daily or 200 mg twice daily, with the aim of evaluating the safety, tolerability, and efficacy of derazantinib monotherapy in this patient population. In Substudy 2, GAC patients with specified FGFR GAs after standard first-line treatment, were treated with a derazantinib-paclitaxel-ramucirumab combination with the aim of evaluating the safety, tolerability, and efficacy of the combination therapy and determining the recommended phase 2 dose (RP2D). The study originally planned to include three substudies but was prematurely terminated for administrative reasons before the third substudy (including combination therapy with derazantinib plus atezolizumab) was initiated.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
47
Derazantinib was administered orally at a dose of 300 mg once daily as monotherapy in the Substudy 1 (Cohort 1.1).
Derazantinib was administered orally at a dose of 200 mg once daily in combination with paclitaxel and ramucirumab. Paclitaxel was administered intravenously at a dose of 80 mg/m² on days 1, 8, and 15 of a 28-day cycle in combination with ramucirumab. Ramucirumab was administered intravenously at a dose of 8 mg/kg every 2 weeks in combination with paclitaxel.
Derazantinib was administered orally at a dose of 300 mg once daily in combination with paclitaxel and ramucirumab. Paclitaxel was administered intravenously at a dose of 80 mg/m² on days 1, 8, and 15 of a 28-day cycle in combination with ramucirumab. Ramucirumab was administered intravenously at a dose of 8 mg/kg every 2 weeks in combination with paclitaxel.
Objective Response Rate (ORR) in Substudy 1 (in Cohorts 1.1 and 1.2)
ORR was defined by the percentage of patients with confirmed complete response (CR, which means disappearance of all target lesions) or partial response (PR, which means \>=30% decrease in the sum of the longest diameter of target lesions) by blinded independent central review (BICR) using the internationally recognized criteria for the radiological assessment in tumor response of solid tumors (RECIST 1.1). Overall Response (OR) = CR + PR. The patients in Cohort 1.1 had FGFR2 fusions or amplification gastric adenocarcinoma (GAC) and FGFR1-3 mutations GAC in Cohort 1.2.
Time frame: From first dose and up to 18 months
Progression-free Survival at 4 Months (PFS4) in Substudy 1 in Cohort 1.3
PFS4 was defined by the percentage of patients alive and free of disease progression (defined as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions) by BICR per RECIST. 1.1. Patients in this Cohort had FGFR fusions, amplifications or mutations GAC
Time frame: From first dose and up to 4 months
Recommended Phase 2 Dose (RP2D) in Substudy 2 (Derazantinib-paclitaxel-ramucirumab in Combination)
RP2D was determined from safety and tolerability according to the aggregate of dose-limiting toxicity criteria and adverse event (AE) data, and considering further pharmacokinetic and efficacy data of the derazantinib-paclitaxel-ramucirumab combination in patients with FGFR fusions, amplifications or mutations GAC.
Time frame: From first dose and up to 18 months
ORR in Substudy 1 in Cohort 1.3
ORR was defined by the percentage of patients with CR or PR by BICR according to RECIST Version 1.1.
Time frame: From first dose and up to 9 months
Disease Control Rate (DCR) in Substudy 1: Cohort 1.1, 1.2 and 1.3 and Combined Cohorts
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Derazantinib was administered orally at a dose of 200 mg twice daily as monotherapy in the Substudy 1 (Cohort 1.3).
Derazantinib was administered orally at a dose of 300 mg once daily as monotherapy in the Substudy 1 (Cohort 1.2).
AdventHealth Cancer Institute
Orlando, Florida, United States
Memorial Sloan Kettering Cancer Center
New York, New York, United States
Fundación Favaloro para la Docencia e Investigación Médica
Buenos Aires, Argentina
Hospital de Gastroenterologia Dr. Carlos Bonorino Udaondo
Ciudad Autonoma Buenos Aires, Argentina
Monash Medical Centre Clayton
Clayton, Australia
Peter MacCallum Cancer Centre
Melbourne, Australia
The Alfred Hospital
Prahran, Australia
UZA
Edegem, Belgium
UZ Leuven
Leuven, Belgium
AZ Delta
Menen, Belgium
...and 71 more locations
Defined as the percentage of patients with confirmed CR, PR or stable disease (SD) by BICR per RECIST version 1.1.
Time frame: From first dose and up to 18 months
PFS in Substudy 1 in Cohort 1.3
PFS was calculated from patient enrollment to progressive disease (PD) date by BICR per RECIST version 1.1
Time frame: From first dose and up to 9 months
Overall Survival (OS) in Substudy 1 in Cohort 1.3
OS was measured from patient enrollment to time of death.
Time frame: From first dose and up to 9 months
OS in Substudy 2
OS was measured from patient enrollment to time of death
Time frame: From first dose and up to 15 months
ORR in Substudy 2
ORR was defined by the percentage of patients with CR or PR by BICR per RECIST version 1.1.
Time frame: From first dose and up to 15 months
DCR in Substudy 2
Defined as the percentage of patients with confirmed CR, PR or SD by BICR per RECIST version 1.1.
Time frame: From first dose and up to 15 months
DOR in Substudy 2 (Separate and Combined Cohorts)
DOR was calculated from the first date of documented tumor response to disease progression by BICR per RECIST version 1.1 (or death if no documentation of PD is obtained).
Time frame: From first dose and up to 15 months
PFS in Substudy 2
PFS was calculated from patient enrollment to progressive disease (PD) date by BICR per RECIST version 1.1.
Time frame: From first dose and up to 15 months
Number of Patients With at Least Grade 3 Treatment-emergent Adverse Events (TEAEs)
Number of patients experiencing TEAE of Grade 3 and above according to Common Terminology Criteria for Adverse Events (CTCAE). CTCAE are a set of criteria for the standardized classification of TEAEs of drugs used in cancer therapy. It uses a range of grades from 1 to 5 describing increasing levels of severity of the TEAEs.
Time frame: TEAEs defined as AEs which were assessed per patient from the patient's first dose and until 90 days after the last dose, which corresponded up to 19 months