Zanidatamab plus chemotherapy as first-line treatment for patients with HER2-positive advanced gastro-oesophageal adenocarcinoma: primary results of a multicentre, single-arm, phase 2 study
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| Publicado en: | Lancet Oncology vol. 26, no. 7 (Jul 2025), p. 847 |
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| Otros Autores: | , , , , , , , , , , , , , , , |
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| Acceso en línea: | Citation/Abstract Full Text Full Text - PDF |
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| 100 | 1 | |a Elimova, Elena |u Department of Gastrointestinal Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada | |
| 245 | 1 | |a Zanidatamab plus chemotherapy as first-line treatment for patients with HER2-positive advanced gastro-oesophageal adenocarcinoma: primary results of a multicentre, single-arm, phase 2 study | |
| 260 | |b Elsevier Limited |c Jul 2025 | ||
| 513 | |a Journal Article | ||
| 520 | 3 | |a Summary Background Zanidatamab, a dual human epidermal growth factor receptor 2 (HER2)-targeted bispecific antibody, previously demonstrated encouraging antitumour activity and a manageable safety profile in patients with treatment-refractory HER2-expressing gastro-oesophageal adenocarcinoma. Here, we evaluated the antitumour activity and safety of zanidatamab plus chemotherapy in first-line HER2-positive advanced gastro-oesophageal adenocarcinoma. Methods This phase 2 trial enrolled patients in Canada, South Korea, and the USA who were aged 18 years and older with untreated, metastatic, or advanced HER2-positive gastro-oesophageal adenocarcinoma (HER2 IHC 3+ or 2+ by local or central assessment [part 1]; HER2 IHC 3+ or 2+ with FISH+ by central assessment [part 2]). Eligible patients, with an Eastern Cooperative Oncology Group performance status of 0 or 1 received zanidatamab intravenously plus standard chemotherapy (CAPOX [capecitabine plus oxaliplatin], FP [5-fluorouracil [5-FU] plus cisplatin], or modified FOLFOX6 [mFOLFOX6; leucovorin, 5-FU, and oxaliplatin]). In our study, part 1 aimed to characterise the safety and tolerability of zanidatamab and find the recommended dose when administered with combination chemotherapy and part 2 aimed to evaluate the antitumour activity of zanidatamab administered with combination chemotherapy in patients receiving first-line treatment for HER2-expressing advanced gastro-oesophageal adenocarcinoma. Two dosing schemes for zanidatamab were used in this study: a weight-based regimen and a two-tiered flat dosing regimen. In the CAPOX and FP groups, patients received either 30 mg/kg zanidatamab or 1800 mg or 2400 mg (patients weighing <70 kg and ≥70 kg, respectively) every 3 weeks. In the CAPOX group, patients also received 1000 mg/m <ce:sup>2</ce:sup> capecitabine orally twice daily on days 1–14 every 3 weeks, plus 130 mg/m <ce:sup>2</ce:sup> oxaliplatin intravenously every 3 weeks. In the FP cohort, patients also received 80 mg/m <ce:sup>2</ce:sup> cisplatin intravenously every 3 weeks, plus 800 mg/m <ce:sup>2</ce:sup> 5-FU per day continuous intravenous infusion on days 1–5 every 3 weeks. In the mFOLFOX6 group, patients received either 20 mg/kg zanidatamab or 1200 mg or 1600 mg for patients weighing under 70 kg or 70 kg and above, respectively, every 2 weeks, plus 400 mg/m <ce:sup>2</ce:sup> intravenous leucovorin every 2 weeks, 85 mg/m <ce:sup>2</ce:sup> intravenous oxaliplatin every 2 weeks, and 1200 mg/m <ce:sup>2</ce:sup> 5-FU per day as a continuous intravenous infusion for 48 h every 2 weeks. mFOLFOX6–1 included the administration of a 400 mg/m <ce:sup>2</ce:sup> 5-FU intravenous bolus on days 1 and 15; mFOLFOX6–2 omitted this 5-FU bolus. The primary endpoints of part 1 were safety and tolerability, which included frequencies of dose-limiting toxicities and dose reductions of zanidatamab and chemotherapy. The primary antitumour activity endpoint of part 2 was confirmed objective response rate assessed in the response-evaluable analysis set. Secondary endpoints included objective response rate, duration of response, disease control rate, clinical benefit rate, progression-free survival, and overall survival. Safety outcomes were assessed in all treated patients. We report the results from an interim analysis. This trial is registered at <ce:inter-ref id="interrefs10" xlink:href="http://ClinicalTrials.gov">ClinicalTrials.gov</ce:inter-ref> ( <ce:inter-ref id="interrefs20" xlink:href="ctgov:NCT03929666">NCT03929666</ce:inter-ref>) and is complete for enrolment. Findings Between Aug 29, 2019, and Feb 18, 2022, 46 patients were enrolled (39 [85%] were male; seven [15%] were female; 28 [61%] were white, 17 [37%] were Asian, and 43 [93%] were not Hispanic or Latino). Median follow-up was 47·9 months (IQR 39·2–53·7); eight (17%) patients were on treatment and 19 (41%) were in survival follow-up. The confirmed objective response rate was 76·2% (95% CI 60·5–87·9) with a median duration of response of 18·7 months (95% CI 10·4–44·1). The median progression-free survival was 12·5 months (95% CI 8·2–21·8) and median overall survival was 36·5 months (23·6–not estimable). The disease control rate was 88·1% (95% CI 74·4–96·0) and clinical benefit rate was 78·6% (95% CI 63·2–89·7). In part 1, there were no dose-limiting toxicities in six patients treated with zanidatamab plus CAPOX. One (50%) of two patients treated with zanidatamab plus FP had dose-limiting toxicities of diarrhoea and acute kidney injury (both grade 3). Two dose-limiting toxicities of diarrhoea (both grade 3) occurred in 2 (15%) of 13 patients receiving 5-FU 400 mg/m <ce:sup>2</ce:sup> bolus on day 1 and 15 as part of the zanidatamab plus mFOLFOX6–1 regimen. 30 (65%) patients had treatment-related grade 3 or 4 adverse events. The most common treatment-related grade 3 or 4 adverse events were diarrhoea (18 [39%]; five [24%] in the 21 patients after implementing mandatory antidiarrhoeal prophylaxis) and hypokalaemia (ten [22%]). Six (13%) patients discontinued zanidatamab due to adverse events. No treatment-related deaths occurred. Interpretation Zanidatamab plus chemotherapy as first-line treatment of HER2-positive advanced gastro-oesophageal adenocarcinoma demonstrated clinically meaningful and durable antitumour activity, with a manageable safety profile. Funding Jazz Pharmaceuticals, Zymeworks. | |
| 651 | 4 | |a United States--US | |
| 653 | |a Monoclonal antibodies | ||
| 653 | |a Standard of care | ||
| 653 | |a Cisplatin | ||
| 653 | |a Metastasis | ||
| 653 | |a Cytotoxicity | ||
| 653 | |a Cancer therapies | ||
| 653 | |a Bispecific antibodies | ||
| 653 | |a Esophageal cancer | ||
| 653 | |a Intravenous administration | ||
| 653 | |a Adenocarcinoma | ||
| 653 | |a Oxaliplatin | ||
| 653 | |a Disease prevention | ||
| 653 | |a Survival | ||
| 653 | |a Metastases | ||
| 653 | |a Kinases | ||
| 653 | |a ErbB-2 protein | ||
| 653 | |a Epidermal growth factor | ||
| 653 | |a Medical prognosis | ||
| 653 | |a Esophagus | ||
| 653 | |a Disease control | ||
| 653 | |a Diarrhea | ||
| 653 | |a Response rates | ||
| 653 | |a Biopsy | ||
| 653 | |a Dosage | ||
| 653 | |a Adverse events | ||
| 653 | |a Safety | ||
| 653 | |a Chemotherapy | ||
| 653 | |a Tumors | ||
| 653 | |a Patients | ||
| 653 | |a 5-Fluorouracil | ||
| 653 | |a Hepatitis | ||
| 700 | 1 | |a Ajani, Jaffer |u Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA | |
| 700 | 1 | |a Burris, Howard |u Department of Medical Oncology, Sarah Cannon Research Institute, Nashville, TN, USA | |
| 700 | 1 | |a Denlinger, Crystal S |u Department of Gastrointestinal Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA | |
| 700 | 1 | |a Iqbal, Syma |u Divison of Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA | |
| 700 | 1 | |a Yoon-Koo, Kang |u Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea | |
| 700 | 1 | |a Kim, Jwa Hoon |u Division of Oncology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul, South Korea | |
| 700 | 1 | |a Lee, Keun-Wook |u Department of Hematology and Medical Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea | |
| 700 | 1 | |a Lin, Bruce |u Section of Hematology-Oncology, Virginia Mason Medical Center, Seattle, WA, USA | |
| 700 | 1 | |a Mehta, Rutika |u Department of Medical Oncology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA | |
| 700 | 1 | |a Do-Youn, Oh |u Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, South Korea | |
| 700 | 1 | |a Sun Young Rha |u Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea | |
| 700 | 1 | |a Young Mi Seol |u Department of Internal Medicine, Pusan National University Hospital, Pusan National University College of Medicine, Busan, South Korea | |
| 700 | 1 | |a Yang, Lin |u Jazz Pharmaceuticals, Palo Alto, CA, USA | |
| 700 | 1 | |a Ozog, Mark A |u Jazz Pharmaceuticals, Palo Alto, CA, USA | |
| 700 | 1 | |a Garfin, Phillip M |u Jazz Pharmaceuticals, Palo Alto, CA, USA | |
| 700 | 1 | |a Ku, Geoffrey |u Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA | |
| 773 | 0 | |t Lancet Oncology |g vol. 26, no. 7 (Jul 2025), p. 847 | |
| 786 | 0 | |d ProQuest |t Health & Medical Collection | |
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