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  • Preliminary results from a Phase I/II study of epacadostat (incb024360) in combination with pembrolizumab in patients with selected advanced cancers

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Preliminary results from a Phase I/II study of epacadostat (incb024360) in combination with pembrolizumab in patients with selected advanced cancers
  1. Tara C Gangadhar1,
  2. Omid Hamid2,
  3. David C Smith3,
  4. Todd M Bauer4,
  5. Jeffrey S Wasser5,
  6. Jason J Luke6,
  7. Ani S Balmanoukian2,
  8. David R Kaufman7,
  9. Yufan Zhao8,
  10. Janet Maleski8,
  11. Lance Leopold8 and
  12. Thomas F Gajewski6
  1. Aff1 grid.25879.310000000419368972Abramson Cancer Center of the University of Pennsylvania Philadelphia PA USA
  2. Aff2 grid.488730.0The Angeles Clinic and Research Institute Los Angeles CA USA
  3. Aff3 grid.214458.e0000000086837370University of Michigan Ann Arbor MI USA
  4. Aff4 grid.492963.30000 0004 0480 9560Sarah Cannon Research InstituteTennessee Oncology, PLLC Nashville TN USA
  5. Aff5 grid.208078.50000000419370394University of Connecticut Health Center Farmington CT USA
  6. Aff6 grid.170205.10000000419367822University of Chicago Chicago IL USA
  7. Aff7 grid.417993.10000000122600793Merck & Co., Inc. Kenilworth NJ USA
  8. Aff8 grid.417921.80000 0004 0451 3241Incyte Corporation Wilmington DE USA

https://doi.org/10.1186/2051-1426-3-S2-O7

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    Meeting abstracts

    Background

    Indoleamine 2,3-dioxygenase 1 (IDO1) is a tryptophan-catabolizing enzyme that is expressed in many cancers and induces immune tolerance by suppressing T cell responses. Epacadostat is a potent, selective oral inhibitor of IDO1. A dose-escalation study of epacadostat with ipilimumab in patients with advanced melanoma showed favorable ORR, disease control rate (DCR), and PFS in immunotherapy-naïve patients [1]. Preliminary data of epacadostat with pembrolizumab in patients with selected advanced cancers are reported.

    Methods

    This is an ongoing dose-escalation and dose-expansion study of epacadostat with pembrolizumab in patients with Stage IIIB, IV, or recurrent NSCLC, melanoma, transitional cell carcinoma (TCC), RCC, endometrial adenocarcinoma (EA), or SCCHN with a 3+3+3 Phase I design (NCT02178722). Patients previously treated with anti-PD-1 or anti-CTLA-4 therapies were excluded. Enrollment is complete in the epacadostat 25 mg BID, 50 mg BID, and 100 mg BID cohorts with pembrolizumab 2 mg/kg IV q3 weeks. Expansion cohorts of epacadostat 50 mg BID, 100 mg BID, and 300 mg BID with pembrolizumab 200 mg are enrolling. Safety, tolerability, and investigator-assessed tumor response (RECIST 1.1) were evaluated.

    Results

    As of August 21, 2015, 54 patients were enrolled. This report includes safety data on 28 patients (melanoma [n=11], RCC [n=5], NSCLC [n=5], TCC [n=3], EA and SCCHN [n=2 each]) and 19 patients evaluable for efficacy as of July 13, 2015. A DLT (grade 3 rash) was observed in 1/8 patients with epacadostat 50 mg BID/pembrolizumab 2 mg/kg; no DLTs were observed with epacadostat 100 mg/pembrolizumab 2 mg/kg. The most common (≥20%) all grade AEs were fatigue, diarrhea, rash, arthralgia, and nausea; the majority of these were grade 1 or 2. Grade ≥3 immune-related AEs were mucosal inflammation and rash (n=1 [4%] each). Reductions in tumor burden were observed in 15/19 evaluable patients. Responses were observed in all tumor types (Table 1), and all are ongoing. In 7 evaluable melanoma patients, ORR was 57% and DCR was 86%, which included 2 CRs. In 5 evaluable RCC patients, ORR was 40% and DCR was 80%. Based on a PK-PD model for epacadostat, nearly all patients' Cavg exceeded the IC50, the range of active drug exposure seen in preclinical models.

    View this table:

    Table 1

    Conclusions

    Epacadostat with pembrolizumab was generally well tolerated and efficacy data suggest promising clinical activity. Correlations between biomarker expression and response are being evaluated. Enrollment in expansion cohorts is ongoing. Updated data will be presented.

    References

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