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Stephen Michael Rothenberg



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    P1.01 - Advanced NSCLC (ID 158)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Advanced NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.01-101 - Efficacy of Immune Checkpoint Inhibition in RET Fusion Positive Non-Small Cell Lung Cancer Patients (ID 1150)

      09:45 - 18:00  |  Author(s): Stephen Michael Rothenberg

      • Abstract

      Background

      Activating RET fusions are oncogenic drivers in 1-2% of non-small cell lung cancer (NSCLC). Ongoing clinical trials indicate that the investigational selective small molecule inhibitor LOXO-292 is efficacious in RET fusion-positive NSCLC patients, with fewer side effects than available anti-RET multikinase inhibitors. While immune checkpoint inhibitors (CPIs) are standard treatment for advanced NSCLC in multiple treatment settings, a growing body of evidence suggests that CPIs are less active in oncogene-driven NSCLC than in driver-negative cancers. We undertook to examine the efficacy of CPIs in a large cohort of RET fusion-positive NSCLC patients

      Method

      A retrospective search for NSCLC patients with RET fusions was performed using multiple electronic health record (EHR) databases. Patients with NSCLC harboring a RET fusion and a history of treatment with a CPI (either as monotherapy or in combination with chemotherapy) were selected. Data extracted from these sources includes: descriptive demographic information such as age and sex, line of therapy in which CPI was administered and time on CPI.

      Result

      106 RET fusions were identified out of over 13,500 total NSCLC patients queried. Of these, over 30 have a history of treatment with a CPI. In this cohort of CPI-treated patients, we will report the time on therapy as the main outcome, which will serve as a surrogate marker for efficacy of CPI in RET fusion NSCLCs.

      Conclusion

      While CPIs are generally accepted to be less effective in EGFR-mutant and ALK fusionpositive NSCLC, their efficacy (or lack thereof) is not understood in other oncogenic driver-positive NSCLCs. The aim of this study is to examine the real-world efficacy of CPIs in RET fusion-positive NSCLC patients identified from multiple EHR databases. These results are expected to guide the selection of CPI and TKI therapy for patients with RET fusion-positive NSCLC.

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    PL02 - Presidential Symposium including Top 7 Rated Abstracts (ID 89)

    • Event: WCLC 2019
    • Type: Plenary Session
    • Track:
    • Presentations: 1
    • Now Available
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      PL02.08 - Registrational Results of LIBRETTO-001: A Phase 1/2 Trial of LOXO-292 in Patients with RET Fusion-Positive Lung Cancers (Now Available) (ID 964)

      08:00 - 10:15  |  Author(s): Stephen Michael Rothenberg

      • Abstract
      • Presentation
      • Slides

      Background

      No targeted therapy is currently approved for patients with RET fusion-positive non-small cell lung cancer (NSCLC). LOXO-292 is a highly selective RET inhibitor with activity against diverse RET fusions, activating RET mutations and brain metastases. Based on initial data from LIBRETTO-001, LOXO-292 received FDA Breakthrough Designation for the treatment of RET fusion-positive NSCLC in August 2018.

      Method

      This global phase 1/2 study (87 sites, 16 countries) enrolled patients with advanced RET-altered solid tumors including RET fusion-positive NSCLC (NCT03157128). LOXO-292 was dosed orally in 28-day cycles. The phase 1 portion established the MTD/RP2D (160 mg BID). The phase 2 portion enrolled patients to one of six cohorts based on tumor type, RET alteration, and prior therapies. The primary endpoint was ORR (RECIST 1.1). Secondary endpoints included DoR, CNS ORR, CNS DoR, PFS, OS, safety and PK.

      Result

      As of 17-June 2019, 253 RET fusion-positive NSCLC patients were treated. The primary analysis set (PAS) for LOXO-292 registration, as defined with the US FDA, consists of the first 105 consecutively enrolled RET fusion-positive NSCLC patients who received prior platinum-based chemotherapy; 58 patients (55%) also received prior anti PD-1/PD-L1 agents. The majority of PAS responders have been followed for ≥6 months from first response. Of the remaining 148 patients, 79 had previously been treated with platinum-based chemotherapy, 55 did not receive prior platinum-based chemotherapy and 14 did not have measurable disease at baseline.

      Among PAS patients, the investigator-assessed ORR was 68% (95% CI 58-76%, n=71/105, 2 PRs pending confirmation). Responses did not differ by fusion partner or the type or number of prior therapies, including chemotherapy, anti PD-1/PD-L1 agents and multikinase inhibitors with anti-RET activity. The median DoR was 20.3 months (95% CI 13.8-24.0) with a median follow-up of 8 months; as evidenced by the wide confidence interval, this DoR estimate is not statistically stable due to a low number of events (16 of 69 confirmed responders). The intracranial ORR was 91% (n=10/11: 2 confirmed CRs, 8 confirmed PRs) for patients with measurable brain metastases at baseline.

      The ORR in efficacy evaluable treatment naïve RET fusion-positive NSCLC patients was 85% (95% CI 69-95%, n=29/34, 7 PRs pending confirmation). In the safety data set of all 531 patients, 5 treatment-related AEs occurred in ≥15% of patients: dry mouth, diarrhea, hypertension, increased AST and increased ALT. Most AEs were grade 1-2. Only 9 of 531 (1.7%) patients discontinued LOXO-292 for treatment-related AEs.

      Conclusion

      LOXO-292 had marked antitumor activity in RET fusion-positive NSCLC patients and was well tolerated. These data will form the basis of an FDA NDA submission later this year.

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