Phase IB study of ziv-aflibercept plus pembrolizumab in patients with advanced solid tumors

• Published in: Journal for immunotherapy of cancer Vol. 10; no. 3; p. e003569
• Main Authors: Rahma, Osama E, Tyan, Kevin, Giobbie-Hurder, Anita, Brohl, Andrew S, Bedard, Philippe L, Renouf, Daniel J, Sharon, Elad, Streicher, Howard, Hathaway, Emma, Cunningham, Rachel, Manos, Michael, Severgnini, Mariano, Rodig, Scott, Stephen Hodi, F
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01-03-2022; BMJ Publishing Group LTD; BMJ; BMJ Publishing Group
• Series: Original research
• Subjects: Angiogenesis; Antibodies, Monoclonal, Humanized; Biomarkers; Breast cancer; Cancer; Carcinoma, Renal Cell - drug therapy; Cell death; clinical trials as topic; Clinical/Translational Cancer Immunotherapy; Colorectal cancer; combination; Disease control; drug therapy; Female; Humans; Immunotherapy; Kidney cancer; Kidney Neoplasms - drug therapy; Kinases; Lymphocytes; Male; Melanoma; Melanoma - drug therapy; Mesothelioma; Metastasis; Monoclonal antibodies; Ovarian cancer; Patients; programmed cell death 1 receptor; Proteins; Receptors, Vascular Endothelial Growth Factor; Recombinant Fusion Proteins; Response rates; Sarcoma; Targeted cancer therapy; Thromboembolism; tumor microenvironment; Tumors; Vascular endothelial growth factor; Canada; United States > US; clinical trials as topic; programmed cell death 1 receptor; drug therapy; tumor microenvironment; immunotherapy; combination
• ISSN: 2051-1426; 2051-1426
• DOI: 10.1136/jitc-2021-003569

BackgroundThe combination of antiangiogenic agents with immune checkpoint inhibitors could potentially overcome immune suppression driven by tumor angiogenesis. We report results from a phase IB study of ziv-aflibercept plus pembrolizumab in patients with advanced solid tumors.MethodsThis is a multicenter phase IB dose-escalation study of the combination of ziv-aflibercept (at 2–4 mg/kg) plus pembrolizumab (at 2 mg/kg) administered intravenously every 2 weeks with expansion cohorts in programmed cell death protein 1 (PD-1)/programmed death-ligand 1(PD-L1)-naïve melanoma, renal cell carcinoma (RCC), microsatellite stable colorectal cancer (CRC), and ovarian cancer. The primary objective was to determine maximum tolerated dose (MTD) and recommended dose of the combination. Secondary endpoints included overall response rate (ORR) and overall survival (OS). Exploratory objectives included correlation of clinical efficacy with tumor and peripheral immune population densities.ResultsOverall, 33 patients were enrolled during dose escalation (n=3) and dose expansion (n=30). No dose-limiting toxicities were reported in the initial dose level. Ziv-aflibercept 4 mg/kg plus pembrolizumab 2 mg/kg every 2 weeks was established as the MTD. Grade ≥3 adverse events occurred in 19/33 patients (58%), the most common being hypertension (36%) and proteinuria (18%). ORR in the dose-expansion cohort was 16.7% (5/30, 90% CI 7% to 32%). Complete responses occurred in melanoma (n=2); partial responses occurred in RCC (n=1), mesothelioma (n=1), and melanoma (n=1). Median OS was as follows: melanoma, not reached (NR); RCC, 15.7 months (90% CI 2.5 to 15.7); CRC, 3.3 months (90% CI 0.6 to 3.4); ovarian, 12.5 months (90% CI 3.8 to 13.6); other solid tumors, NR. Activated tumor-infiltrating CD8 T cells at baseline (CD8+PD1+), high CD40L expression, and increased peripheral memory CD8 T cells correlated with clinical response.ConclusionThe combination of ziv-aflibercept and pembrolizumab demonstrated an acceptable safety profile with antitumor activity in solid tumors. The combination is currently being studied in sarcoma and anti-PD-1-resistant melanoma.Trial registration numberNCT02298959.