RT Journal Article
SR Electronic
T1 Phase II trial of the IDO pathway inhibitor indoximod plus pembrolizumab for the treatment of patients with advanced melanoma
JF Journal for ImmunoTherapy of Cancer
JO J Immunother Cancer
FD BMJ Publishing Group Ltd
SP e002057
DO 10.1136/jitc-2020-002057
VO 9
IS 6
A1 Yousef Zakharia
A1 Robert R McWilliams
A1 Olivier Rixe
A1 Joseph Drabick
A1 Montaser F Shaheen
A1 Kenneth F Grossmann
A1 Ravindra Kolhe
A1 Rafal Pacholczyk
A1 Ramses Sadek
A1 Lucinda L Tennant
A1 Christopher M Smith
A1 Eugene P Kennedy
A1 Charles J Link Jr
A1 Nicholas N Vahanian
A1 Jiayi Yu
A1 Steven S Shen
A1 Erik L Brincks
A1 Gabriela R Rossi
A1 David Munn
A1 Mohammed Milhem
YR 2021
UL http://jitc.bmj.com/content/9/6/e002057.abstract
AB Background The indoleamine 2,3-dioxygenase (IDO) pathway is a key counter-regulatory mechanism that, in cancer, is exploited by tumors to evade antitumor immunity. Indoximod is a small-molecule IDO pathway inhibitor that reverses the immunosuppressive effects of low tryptophan (Trp) and high kynurenine (Kyn) that result from IDO activity. In this study, indoximod was used in combination with a checkpoint inhibitor (CPI) pembrolizumab for the treatment for advanced melanoma.Methods Patients with advanced melanoma were enrolled in a single-arm phase II clinical trial evaluating the addition of indoximod to standard of care CPI approved for melanoma. Investigators administered their choice of CPI including pembrolizumab (P), nivolumab (N), or ipilimumab (I). Indoximod was administered continuously (1200 mg orally two times per day), with concurrent CPI dosed per US Food and Drug Administration (FDA)-approved label.Results Between July 2014 and July 2017, 131 patients were enrolled. (P) was used more frequently (n=114, 87%) per investigator’s choice. The efficacy evaluable population consisted of 89 patients from the phase II cohort with non-ocular melanoma who received indoximod combined with (P).The objective response rate (ORR) for the evaluable population was 51% with confirmed complete response of 20% and disease control rate of 70%. Median progression-free survival was 12.4 months (95% CI 6.4 to 24.9). The ORR for Programmed Death-Ligand 1 (PD-L1)-positive patients was 70% compared with 46% for PD-L1-negative patients. The combination was well tolerated, and side effects were similar to what was expected from single agent (P).Conclusion In this study, the combination of indoximod and (P) was well tolerated and showed antitumor efficacy that is worth further evaluation in selected patients with advanced melanoma.Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Availability of data and material: All data relevant to the study are included in the article or uploaded as online supplemental information. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.