Erdafitinib in locally advanced or metastatic urothelial carcinoma

Y. Loriot, A. Necchi, S. H. Park, J. Garcia-Donas, R. Huddart, E. Burgess, M. Fleming, A. Rezazadeh, B. Mellado, S. Varlamov, M. Joshi, I. Duran, S. T. Tagawa, Y. Zakharia, B. Zhong, K. Stuyckens, A. Santiago-Walker, P. De Porre, A. O'Hagan, A. AvadhaniA. O. Siefker-Radtke

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Abstract

BACKGROUND: Alterations in the gene encoding fibroblast growth factor receptor (FGFR) are common in urothelial carcinoma and may be associated with lower sensitivity to immune interventions. Erdafitinib, a tyrosine kinase inhibitor of FGFR1-4, has shown antitumor activity in preclinical models and in a phase 1 study involving patients with FGFR alterations. METHODS: In this open-label, phase 2 study, we enrolled patients who had locally advanced and unresectable or metastatic urothelial carcinoma with prespecified FGFR alterations. All the patients had a history of disease progression during or after at least one course of chemotherapy or within 12 months after neoadjuvant or adjuvant chemotherapy. Prior immunotherapy was allowed. We initially randomly assigned the patients to receive erdafitinib in either an intermittent or a continuous regimen in the dose-selection phase of the study. On the basis of an interim analysis, the starting dose was set at 8 mg per day in a continuous regimen (selected-regimen group), with provision for a pharmacodynamically guided dose escalation to 9 mg. The primary end point was the objective response rate. Key secondary end points included progression-free survival, duration of response, and overall survival. RESULTS: A total of 99 patients in the selected-regimen group received a median of five cycles of erdafitinib. Of these patients, 43% had received at least two previous courses of treatment, 79% had visceral metastases, and 53% had a creatinine clearance of less than 60 ml per minute. The rate of confirmed response to erdafitinib therapy was 40% (3% with a complete response and 37% with a partial response). Among the 22 patients who had undergone previous immunotherapy, the confirmed response rate was 59%. The median duration of progression-free survival was 5.5 months, and the median duration of overall survival was 13.8 months. Treatment-related adverse events of grade 3 or higher, which were managed mainly by dose adjustments, were reported in 46% of the patients; 13% of the patients discontinued treatment because of adverse events. There were no treatment-related deaths. CONCLUSIONS: The use of erdafitinib was associated with an objective tumor response in 40% of previously treated patients who had locally advanced and unresectable or metastatic urothelial carcinoma with FGFR alterations. Treatment-related grade 3 or higher adverse events were reported in nearly half the patients.

Original languageEnglish (US)
Pages (from-to)338-348
Number of pages11
JournalNew England Journal of Medicine
Volume381
Issue number4
DOIs
StatePublished - Jul 25 2019

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Carcinoma
Fibroblast Growth Factor Receptors
Immunotherapy
Disease-Free Survival
Therapeutics
Receptor, Fibroblast Growth Factor, Type 1
Survival
Adjuvant Chemotherapy
Disease Progression
Creatinine
Neoplasm Metastasis
Drug Therapy
Genes
Neoplasms

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Loriot, Y., Necchi, A., Park, S. H., Garcia-Donas, J., Huddart, R., Burgess, E., ... Siefker-Radtke, A. O. (2019). Erdafitinib in locally advanced or metastatic urothelial carcinoma. New England Journal of Medicine, 381(4), 338-348. https://doi.org/10.1056/NEJMoa1817323
Loriot, Y. ; Necchi, A. ; Park, S. H. ; Garcia-Donas, J. ; Huddart, R. ; Burgess, E. ; Fleming, M. ; Rezazadeh, A. ; Mellado, B. ; Varlamov, S. ; Joshi, M. ; Duran, I. ; Tagawa, S. T. ; Zakharia, Y. ; Zhong, B. ; Stuyckens, K. ; Santiago-Walker, A. ; De Porre, P. ; O'Hagan, A. ; Avadhani, A. ; Siefker-Radtke, A. O. / Erdafitinib in locally advanced or metastatic urothelial carcinoma. In: New England Journal of Medicine. 2019 ; Vol. 381, No. 4. pp. 338-348.
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abstract = "BACKGROUND: Alterations in the gene encoding fibroblast growth factor receptor (FGFR) are common in urothelial carcinoma and may be associated with lower sensitivity to immune interventions. Erdafitinib, a tyrosine kinase inhibitor of FGFR1-4, has shown antitumor activity in preclinical models and in a phase 1 study involving patients with FGFR alterations. METHODS: In this open-label, phase 2 study, we enrolled patients who had locally advanced and unresectable or metastatic urothelial carcinoma with prespecified FGFR alterations. All the patients had a history of disease progression during or after at least one course of chemotherapy or within 12 months after neoadjuvant or adjuvant chemotherapy. Prior immunotherapy was allowed. We initially randomly assigned the patients to receive erdafitinib in either an intermittent or a continuous regimen in the dose-selection phase of the study. On the basis of an interim analysis, the starting dose was set at 8 mg per day in a continuous regimen (selected-regimen group), with provision for a pharmacodynamically guided dose escalation to 9 mg. The primary end point was the objective response rate. Key secondary end points included progression-free survival, duration of response, and overall survival. RESULTS: A total of 99 patients in the selected-regimen group received a median of five cycles of erdafitinib. Of these patients, 43{\%} had received at least two previous courses of treatment, 79{\%} had visceral metastases, and 53{\%} had a creatinine clearance of less than 60 ml per minute. The rate of confirmed response to erdafitinib therapy was 40{\%} (3{\%} with a complete response and 37{\%} with a partial response). Among the 22 patients who had undergone previous immunotherapy, the confirmed response rate was 59{\%}. The median duration of progression-free survival was 5.5 months, and the median duration of overall survival was 13.8 months. Treatment-related adverse events of grade 3 or higher, which were managed mainly by dose adjustments, were reported in 46{\%} of the patients; 13{\%} of the patients discontinued treatment because of adverse events. There were no treatment-related deaths. CONCLUSIONS: The use of erdafitinib was associated with an objective tumor response in 40{\%} of previously treated patients who had locally advanced and unresectable or metastatic urothelial carcinoma with FGFR alterations. Treatment-related grade 3 or higher adverse events were reported in nearly half the patients.",
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Loriot, Y, Necchi, A, Park, SH, Garcia-Donas, J, Huddart, R, Burgess, E, Fleming, M, Rezazadeh, A, Mellado, B, Varlamov, S, Joshi, M, Duran, I, Tagawa, ST, Zakharia, Y, Zhong, B, Stuyckens, K, Santiago-Walker, A, De Porre, P, O'Hagan, A, Avadhani, A & Siefker-Radtke, AO 2019, 'Erdafitinib in locally advanced or metastatic urothelial carcinoma', New England Journal of Medicine, vol. 381, no. 4, pp. 338-348. https://doi.org/10.1056/NEJMoa1817323

Erdafitinib in locally advanced or metastatic urothelial carcinoma. / Loriot, Y.; Necchi, A.; Park, S. H.; Garcia-Donas, J.; Huddart, R.; Burgess, E.; Fleming, M.; Rezazadeh, A.; Mellado, B.; Varlamov, S.; Joshi, M.; Duran, I.; Tagawa, S. T.; Zakharia, Y.; Zhong, B.; Stuyckens, K.; Santiago-Walker, A.; De Porre, P.; O'Hagan, A.; Avadhani, A.; Siefker-Radtke, A. O.

In: New England Journal of Medicine, Vol. 381, No. 4, 25.07.2019, p. 338-348.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Erdafitinib in locally advanced or metastatic urothelial carcinoma

AU - Loriot, Y.

AU - Necchi, A.

AU - Park, S. H.

AU - Garcia-Donas, J.

AU - Huddart, R.

AU - Burgess, E.

AU - Fleming, M.

AU - Rezazadeh, A.

AU - Mellado, B.

AU - Varlamov, S.

AU - Joshi, M.

AU - Duran, I.

AU - Tagawa, S. T.

AU - Zakharia, Y.

AU - Zhong, B.

AU - Stuyckens, K.

AU - Santiago-Walker, A.

AU - De Porre, P.

AU - O'Hagan, A.

AU - Avadhani, A.

AU - Siefker-Radtke, A. O.

PY - 2019/7/25

Y1 - 2019/7/25

N2 - BACKGROUND: Alterations in the gene encoding fibroblast growth factor receptor (FGFR) are common in urothelial carcinoma and may be associated with lower sensitivity to immune interventions. Erdafitinib, a tyrosine kinase inhibitor of FGFR1-4, has shown antitumor activity in preclinical models and in a phase 1 study involving patients with FGFR alterations. METHODS: In this open-label, phase 2 study, we enrolled patients who had locally advanced and unresectable or metastatic urothelial carcinoma with prespecified FGFR alterations. All the patients had a history of disease progression during or after at least one course of chemotherapy or within 12 months after neoadjuvant or adjuvant chemotherapy. Prior immunotherapy was allowed. We initially randomly assigned the patients to receive erdafitinib in either an intermittent or a continuous regimen in the dose-selection phase of the study. On the basis of an interim analysis, the starting dose was set at 8 mg per day in a continuous regimen (selected-regimen group), with provision for a pharmacodynamically guided dose escalation to 9 mg. The primary end point was the objective response rate. Key secondary end points included progression-free survival, duration of response, and overall survival. RESULTS: A total of 99 patients in the selected-regimen group received a median of five cycles of erdafitinib. Of these patients, 43% had received at least two previous courses of treatment, 79% had visceral metastases, and 53% had a creatinine clearance of less than 60 ml per minute. The rate of confirmed response to erdafitinib therapy was 40% (3% with a complete response and 37% with a partial response). Among the 22 patients who had undergone previous immunotherapy, the confirmed response rate was 59%. The median duration of progression-free survival was 5.5 months, and the median duration of overall survival was 13.8 months. Treatment-related adverse events of grade 3 or higher, which were managed mainly by dose adjustments, were reported in 46% of the patients; 13% of the patients discontinued treatment because of adverse events. There were no treatment-related deaths. CONCLUSIONS: The use of erdafitinib was associated with an objective tumor response in 40% of previously treated patients who had locally advanced and unresectable or metastatic urothelial carcinoma with FGFR alterations. Treatment-related grade 3 or higher adverse events were reported in nearly half the patients.

AB - BACKGROUND: Alterations in the gene encoding fibroblast growth factor receptor (FGFR) are common in urothelial carcinoma and may be associated with lower sensitivity to immune interventions. Erdafitinib, a tyrosine kinase inhibitor of FGFR1-4, has shown antitumor activity in preclinical models and in a phase 1 study involving patients with FGFR alterations. METHODS: In this open-label, phase 2 study, we enrolled patients who had locally advanced and unresectable or metastatic urothelial carcinoma with prespecified FGFR alterations. All the patients had a history of disease progression during or after at least one course of chemotherapy or within 12 months after neoadjuvant or adjuvant chemotherapy. Prior immunotherapy was allowed. We initially randomly assigned the patients to receive erdafitinib in either an intermittent or a continuous regimen in the dose-selection phase of the study. On the basis of an interim analysis, the starting dose was set at 8 mg per day in a continuous regimen (selected-regimen group), with provision for a pharmacodynamically guided dose escalation to 9 mg. The primary end point was the objective response rate. Key secondary end points included progression-free survival, duration of response, and overall survival. RESULTS: A total of 99 patients in the selected-regimen group received a median of five cycles of erdafitinib. Of these patients, 43% had received at least two previous courses of treatment, 79% had visceral metastases, and 53% had a creatinine clearance of less than 60 ml per minute. The rate of confirmed response to erdafitinib therapy was 40% (3% with a complete response and 37% with a partial response). Among the 22 patients who had undergone previous immunotherapy, the confirmed response rate was 59%. The median duration of progression-free survival was 5.5 months, and the median duration of overall survival was 13.8 months. Treatment-related adverse events of grade 3 or higher, which were managed mainly by dose adjustments, were reported in 46% of the patients; 13% of the patients discontinued treatment because of adverse events. There were no treatment-related deaths. CONCLUSIONS: The use of erdafitinib was associated with an objective tumor response in 40% of previously treated patients who had locally advanced and unresectable or metastatic urothelial carcinoma with FGFR alterations. Treatment-related grade 3 or higher adverse events were reported in nearly half the patients.

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Loriot Y, Necchi A, Park SH, Garcia-Donas J, Huddart R, Burgess E et al. Erdafitinib in locally advanced or metastatic urothelial carcinoma. New England Journal of Medicine. 2019 Jul 25;381(4):338-348. https://doi.org/10.1056/NEJMoa1817323