학술논문
Nivolumab for mismatch-repair-deficient or hypermutated gynecologic cancers: a phase 2 trial with biomarker analyses
Document Type
Article
Author
Friedman, Claire F.; Manning-Geist, Beryl L.; Zhou, Qin; Soumerai, Tara; Holland, Aliya; Da Cruz Paula, Arnaud; Green, Hunter; Ozsoy, Melih Arda; Iasonos, Alexia; Hollmann, Travis; Leitao, Mario M.; Mueller, Jennifer J.; Makker, Vicky; Tew, William P.; O’Cearbhaill, Roisin E.; Liu, Ying L.; Rubinstein, Maria M.; Troso-Sandoval, Tiffany; Lichtman, Stuart M.; Schram, Alison; Kyi, Chrisann; Grisham, Rachel N.; Causa Andrieu, Pamela; Wherry, E. John; Aghajanian, Carol; Weigelt, Britta; Hensley, Martee L.; Zamarin, Dmitriy
Source
Nature Medicine; 20240101, Issue: Preprints p1-9, 9p
Subject
Language
ISSN
10788956; 1546170X
Abstract
Programmed death-1 (PD-1) inhibitors are approved for therapy of gynecologic cancers with DNA mismatch repair deficiency (dMMR), although predictors of response remain elusive. We conducted a single-arm phase 2 study of nivolumab in 35 patients with dMMR uterine or ovarian cancers. Co-primary endpoints included objective response rate (ORR) and progression-free survival at 24 weeks (PFS24). Secondary endpoints included overall survival (OS), disease control rate (DCR), duration of response (DOR) and safety. Exploratory endpoints included biomarkers and molecular correlates of response. The ORR was 58.8% (97.5% confidence interval (CI): 40.7–100%), and the PFS24 rate was 64.7% (97.5% one-sided CI: 46.5–100%), meeting the pre-specified endpoints. The DCR was 73.5% (95% CI: 55.6–87.1%). At the median follow-up of 42.1 months (range, 8.9–59.8 months), median OS was not reached. One-year OS rate was 79% (95% CI: 60.9–89.4%). Thirty-two patients (91%) had a treatment-related adverse event (TRAE), including arthralgia (n= 10, 29%), fatigue (n= 10, 29%), pain (n= 10, 29%) and pruritis (n= 10, 29%); most were grade 1 or grade 2. Ten patients (29%) reported a grade 3 or grade 4 TRAE; no grade 5 events occurred. Exploratory analyses show that the presence of dysfunctional (CD8+PD-1+) or terminally dysfunctional (CD8+PD-1+TOX+) T cells and their interaction with programmed death ligand-1 (PD-L1)+cells were independently associated with PFS24. PFS24 was associated with presence of MEGF8or SETD1Bsomatic mutations. This trial met its co-primary endpoints (ORR and PFS24) early, and our findings highlight several genetic and tumor microenvironment parameters associated with response to PD-1 blockade in dMMR cancers, generating rationale for their validation in larger cohorts.