ASCO 2016: Novel Antibody Significantly Improves Survival in Patients With Advanced Gastric Cancer
Findings from the European phase II FAST study showed that the novel, first-in-class antibody IMAB362 can significantly extend median survival when added to standard chemotherapy (13.2 vs 8.4 months) for patients with advanced gastric cancer. This therapy targets a protein called claudin-18 splice variant 2 (CLDN18.2), and patients in the study with the highest levels of CLDN18.2 had an even longer median overall survival (16.7 months).
The study by Al-Batran et al was presented in a press briefing today at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract LBA4001).
“As CLDN18.2 is abundant in gastric tumors, we estimate that half of all patients with advanced gastric cancer may be candidates for this new treatment,” said lead study author Salah-Eddin Al-Batran, MD, a medical oncologist and Director at the Institute of Clinical Cancer Research, Nordwest Hospital in Frankfurt am Main, Germany. “In addition, this unique target is not present in any healthy tissues except the lining of the stomach, thereby minimizing treatment side effects.”
A Novel Cancer Target
Besides gastric cancer, CLDN18.2 is found in a variety of other tumors, including pancreatic, lung, esophageal, and ovarian. CLDN18.2 belongs to a family of proteins that make tight junctions, which control the flow of molecules between cells in a layer. In tumors, however, tight junctions become disrupted and claudin proteins lose their primary role.
IMAB362 is the first antibody to target CLDN18.2. When the antibodies attach to CLDN18.2 on the surface of cancer cells, various types of cellular and soluble immune effectors respond by killing the cancer cells that are coated with antibodies. These processes are known as antibody-dependent cell-mediated cytotoxicity and complement-dependent cytotoxicity.
FAST Study
Gastric cancer is the fifth most common cancer in the world, with nearly 1 million new patients diagnosed with this disease in 2012. The standard initial treatment for advanced or recurrent gastric cancer is chemotherapy. The addition of trastuzumab (Herceptin) to chemotherapy provides some benefit to the group of patients with HER2-positive tumors, but only 15% all gastric cancers are HER2-positive.
The study included 161 patients with advanced or recurrent gastric or gastroesophageal junction cancer with a specific minimal level of CLDN18.2 in the tumor (assessed from analysis of tumor biopsy specimen with a validated CE-marked diagnostic assay). The patients had not received prior therapy for metastatic cancer and were not eligible to receive HER2-targeted therapy with trastuzumab. The patients were randomly assigned to receive standard chemotherapy (epirubicin, oxaliplatin, and capecitabine) alone or with IMAB362.
Key Findings
Compared to chemotherapy alone, IMAB362 extended the median time to disease progression from 4.8 to 7.9 months and the median overall survival from 8.4 to 13.2 months. Among the patients with the highest levels of CLDN18.2, the median overall survival was 16.7 months with IMAB362 and 9 months with chemotherapy alone.
According to the authors, the treatment was well tolerated. Vomiting (34.5% of patients with grade 1/2 and 3.6% with grade 3/4 in control arm vs 55.8% of patients with grade 1/2 and in 10.4% with grade 3/4 in IMAB362 arm) and low blood counts or neutropenia (21.4 % of patients with grade 1/2 and 21.4 % with grade 3/4 in control arm vs 23.4% of patients with grade 1/2 and in 32.5% with grade 3/4 in IMAB362 arm) were slightly more common in the IMAB362 group. The rates of severe adverse effects were not increased with IMAB362 compared to chemotherapy alone.
Next Steps
“It’s exciting to see immunotherapy improving survival in gastric cancer. CLDN18.2 is commonly expressed in multiple cancers, and this treatment may apply to half of all patients with gastric cancer,” said Smitha Krishnamurthi, MD, ASCO Expert in gastric cancer and moderator of today’s press briefing.
A phase III study is planned for launch in early 2017. The researchers are also planning a phase II study of IMAB362 in patients with pancreatic cancer.
This study received funding from Ganymed Pharmaceuticals AG.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
