Efficacy and safety of dendrimer-enhanced (DEP) cabazitaxel (DEP CTX) in patients with advanced solid cancers in a phase 1/2 trial (P1/2).

James F. Spicer King's College London, London, United Kingdom info_outline James F. Spicer, David James Pinato, Martin Forster, Anthony M. Joshua, James Korolewicz, Karam Aboud, Cienne Morton, Jia (Jenny) Liu, Rasha Cosman, Nicola Jane Main, Julia Le Meur, Jeremy Paull, Stephanie Ruth Edmondson, Robert Hugh Jones

Authors James F. Spicer King's College London, London, United Kingdom info_outline James F. Spicer, David James Pinato, Martin Forster, Anthony M. Joshua, James Korolewicz, Karam Aboud, Cienne Morton, Jia (Jenny) Liu, Rasha Cosman, Nicola Jane Main, Julia Le Meur, Jeremy Paull, Stephanie Ruth Edmondson, Robert Hugh Jones Organizations King's College London, London, United Kingdom, Imperial College, London, United Kingdom, University College London Cancer Institute, University College London Hospital NHS Trust, London, United Kingdom, Kinghorn Cancer Centre, Sydney, Australia, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom, Velindre Cancer Centre, Whitechurch, United Kingdom, Guy's Hospital, London, United Kingdom, The Kinghorn Cancer Centre, St. Vincent's Hospital, Darlinghurst, NSW, Australia, Starpharma Pty Ltd., Melbourne, Australia, Velindre Cancer Centre, Cardiff, United Kingdom Abstract Disclosures Research Funding Starpharma Pty Ltd Background: DEP CTX is a highly optimized dendrimer nanoparticle formulation of cabazitaxel that achieves sustained cytotoxic drug delivery to tumors via enhanced permeability & retention effects. Unlike standard cabazitaxel (s-CTX), DEP CTX is highly water soluble, does not contain toxic excipients associated with anaphylaxis & does not require steroid/antihistamine premedication. We report the final P2 efficacy and safety results in patients (pts) with advanced/metastatic solid tumors. Methods: Pts were treated with DEP CTX at 20 mg/m2 cabazitaxel, IV 3-weekly. Efficacy was assessed by RECIST v1.1, Prostate Cancer Working Group 3 (PCWG3) guidelines or serum tumor markers; evaluable pts had relevant criteria at baseline and a follow-up assessment per protocol window. Safety was assessed by CTCAE v4.03. (EudraCT 2017-003424-76). Results: In P2, 75 pts were enrolled, prioritizing metastatic castration-resistant prostate cancer (mCRPC, s-CTX’s only approved indication), esophagogastric (EG) & ovarian (OV) cancers. For all pts, median progression free survival (mPFS) and overall survival (mOS) were 3.8 and 9.0 mths, respectively. Objective response rate (ORR) was 20% in 45 evaluable pts. All 25mCRPC pts were heavily pre-treated with a median of 4 prior lines of anticancer treatment. mPFS was 4.4 mths (radiographic or prostate specific antigen [PSA]); mOS was 14.7 mths. The disease control rate (DCR) was 70.6%; ORR was 16.7%. PSA reduced in 90% pts (by > 50% in 52.4%); 87% with bone metastases had no progression or improved. Of 15 EG pts, 9 were adenocarcinoma (ADENO) (3 gastric, 2 esophageal & 4 EG junction) & 6 were esophageal squamous cell carcinoma (SCC). For all EG pts, mPFS was 4.0 mths, mOS was 8.6 mths. mPFS was 4.0/1.9 mths for ADENO/SCC, respectively. Overall, DCR was 80%; ORR 30%. DCR was 100%/50% and the ORR was 33%/25% for ADENO/SCC, respectively. Of 22 OV pts, 96% were platinum resistant (Pt-R), with a median of 4 prior lines of anticancer treatment, including 59% with ≥ 3 platinum lines. mPFS/mOS were 3.1 mths & not reached, respectively. DCR was 66.7%; ORR 17.6%. Treatment related adverse events (TRAEs) were mostly mild/moderate (grade (G) 1/2; 64%/25%). Only 21% of pts had G 3/4 non-hematological TRAEs, while G3/4 lab detected neutropenia was seen in only 23% of pts despite no routine G-CSF. TRAEs observed in ≥10% of pts included fatigue, neutropenia, anemia, thrombocytopenia, diarrhea, nausea, vomiting, peripheral neuropathy and decreased appetite. Conclusions: DEP CTX exhibited clinically meaningful, durable antitumor activity in multiple advanced solid cancers, including mCRPC, Pt-R OV and EG cancers without the need for steroid premedication. The antitumor activity & safety results compare favorably to s-CTX, or standard of care chemotherapy in non-prostate cancers, and highlight the promising potential of dendrimer-enhanced delivery of cabazitaxel. Clinical trial information: 2017-003424-76.