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Efficacy, Safety, and Biomarkers of Toripalimab in Patients with Recurrent or Metastatic Neuroendocrine Neoplasms: A Multiple-Center Phase Ib Trial.
Clinical Cancer Research ( IF 11.5 ) Pub Date : 2020-02-21 , DOI: 10.1158/1078-0432.ccr-19-4000 Ming Lu 1 , Panpan Zhang 1 , Yanqiao Zhang 2 , Zhongwu Li 3 , Jifang Gong 1 , Jie Li 1 , Jian Li 1 , Yan Li 1 , Xiaotian Zhang 1 , Zhihao Lu 1 , Xicheng Wang 1 , Jun Zhou 1 , Zhi Peng 1 , Weifeng Wang 4 , Hui Feng 5 , Hai Wu 5 , Sheng Yao 5 , Lin Shen 1
Clinical Cancer Research ( IF 11.5 ) Pub Date : 2020-02-21 , DOI: 10.1158/1078-0432.ccr-19-4000 Ming Lu 1 , Panpan Zhang 1 , Yanqiao Zhang 2 , Zhongwu Li 3 , Jifang Gong 1 , Jie Li 1 , Jian Li 1 , Yan Li 1 , Xiaotian Zhang 1 , Zhihao Lu 1 , Xicheng Wang 1 , Jun Zhou 1 , Zhi Peng 1 , Weifeng Wang 4 , Hui Feng 5 , Hai Wu 5 , Sheng Yao 5 , Lin Shen 1
Affiliation
PURPOSE
Patients with recurrent or metastatic neuroendocrine neoplasms (NEN) had a poor prognosis and few treatment options. Toripalimab, a humanized IgG4 antibody specific for human PD-1 receptor, was first approved to treat second-line metastatic melanoma in China in 2018.
PATIENTS AND METHODS
The multiple-center phase Ib trial enrolled patients with NENs (Ki-67 ≥ 10%) after failure of first-line therapy received 3 mg/kg toripalimab once every two weeks. The primary objective was objective response rate (ORR) and safety. PD-L1 expression and whole-exome sequencing were performed on tumor biopsies. Secondary objectives included duration of response (DOR), disease control rate (DCR), and progression-free survival and overall survival.
RESULTS
Of 40 patients included from April 2017 to December 2018, 8 partial responses and 6 stable diseases were observed, for a 20% ORR and a 35% DCR. The median DOR was 15.2 months. Patients with PD-L1 expression (≥10%) or high tumor mutational burden (TMB) had better ORR than PD-L1 <10% (50.0% vs. 10.7%, P = 0.019) and TMB-low patients (75.0% vs. 16.1%, P = 0.03). Three of 8 (37.5%) responders harbored ARID1A mutations, whereas only 1 of 27 nonresponders had mutations (P = 0.03). Of note, 1 exceptional responder with TMB-L, microsatellite stable (MSS), and PD-L1-negative had multiple genomic arrangements with high prediction score for neoantigens.
CONCLUSIONS
Toripalimab had antitumor activity and safety in treating recurrent or metastatic NENs. Patients with positive PD-L1 expression, TMB-H (top 10%), and/or microsatellite instable (MSI-H) might preferentially benefit from the treatment. The genomic mutation of ARID1A and high genomic rearrangements might be correlated with clinical benefit.
更新日期：2020-05-15
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