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Background: Src, the first proto-oncogene to be described, is a non-receptor tyrosine kinase interacting with multiple oncogenic pathways, including cell proliferation, survival, angiogenesis and osteoclast activity. Src activation occurs in up to 40% of ER+ breast cancers, is linked with poor prognosis, and pre-clinically has been strongly implicated in endocrine resistance. Saracatinib (AZD0530) is a potent, oral selective Src inhibitor that enhances the anti-proliferative effect of endocrine agents in pre-clinical breast cancer models, preventing the development of endocrine-resistance and restoring endocrine sensitivity. In a murine model of prostate bony metastases saracatinib inhibits osteoclast activity, reducing bone resorption and the development and progression of bone lesions. Clinically, saracatinib is generally well-tolerated with mainly gastro-intestinal adverse events (AEs), clinically meaningful durations of stable disease as monotherapy, and partial responses observed in combination with other therapies. Methods: Multi-centre, placebo-controlled, double-blind, randomised phase II trial. Post-menopausal women with advanced/metastatic breast cancer suitable for 1st or 2nd second line hormonal treatment, were randomised to receive an aromatase inhibitor (AI) plus saracatinib 175mg mg/day or placebo. Patients were stratified as either (i) “AI-sensitive/naïve”, who received anastrazole 1mg daily ± saracatinib, or (ii) “prior-AI”, if they had progressed on a non-steroidal AI but were considered likely to retain some endocrine sensitivity, who received exemestane 25mg daily ± saracatinib. Other stratification factors were bone metastases, bisphosphonate use, performance status, and treatment centre. Treatment was until progression, intolerable toxicity or at the patient’s request. The primary endpoint was PFS; secondary endpoints were toxicity, ORR & OS; exploratory endpoints explored molecular correlates in on-treatment samples (including optional biopsies). Results: 140 patients were enrolled from 22 UK sites between August 2012 and April 2015 of whom 69 were in the “AI-sensitive/naïve” group and 71 in the “prior-AI” group; 134 patients were eligible for efficacy evaluation and 136 for safety. Interim safety data analyses by an IDMC identified no new safety signals. Treatment emergent AEs were generally low grade, the most frequent being fatigue (70%) and nausea (49%); AEs occurring significantly (p Conclusions: Saractinib did not improve outcomes in post-menopausal women with advanced breast cancer treated with exemestane with numerically inferior p response rate and PFS, and no apparent beneficial effect on bone metastases. These data do not support further evaluation of saracatinib in combination with AIs. ARISTACAT - Abstract - San Antonio 2019 Citation Format: David Cameron, Stefan Symeonides, Murray Brunt, Peter Schmid, Simon Waters, Christopher Twelves, Peter Barrett-Lee, John Bartlett, Tammy Piper, Karen McAdam, Eve Macdonald Chisholm, Michelle Welsh, Robert Hill. ARISTACAT - Aromatase inhibition plus minus saracatinib as advanced breast cancer therapy: A randomised phase II study of aromatase inhibition plus/minus the Src-inhibitor AZD0530 in post-menopausal women with advanced breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-11-09.

Background The continual reassessment method (CRM) identifies the maximum tolerated dose (MTD) more efficiently and identifies the true MTD more frequently compared to standard methods such as the 3 + 3 method. An initial estimate of the dose-toxicity relationship (prior skeleton) is required, and there is limited guidance on how to select this. Previously, we compared the CRM with six different skeletons to the 3 + 3 method by conducting post-hoc analysis on a phase 1 oncology study (AZD3514), each CRM model reduced the number of patients allocated to suboptimal and toxic doses. This manuscript extends this work by assessing the ability of the 3 + 3 method and the CRM with different skeletons in determining the true MTD of various “true” dose-toxicity relationships. Methods One thousand studies were simulated for each “true” dose toxicity relationship considered, four were based on clinical trial data (AZD3514, AZD1208, AZD1480, AZD4877), and four were theoretical. The 3 + 3 method and 2-stage extended CRM with six skeletons were applied to identify the MTD, where the true MTD was considered as the largest dose where the probability of experiencing a dose limiting toxicity (DLT) is ≤33%. Results For every true dose-toxicity relationship, the CRM selected the MTD that matched the true MTD in a higher proportion of studies compared to the 3 + 3 method. The CRM overestimated the MTD in a higher proportion of simulations compared to the 3 + 3 method. The proportion of studies where the correct MTD was selected varied considerably between skeletons. For some true dose-toxicity relationships, some skeletons identified the true MTD in a higher proportion of scenarios compared to the skeleton that matched the true dose-toxicity relationship. Conclusion Through simulation, the CRM generally outperformed the 3 + 3 method for the clinical and theoretical true dose-toxicity relationships. It was observed that accurate estimates of the true skeleton do not always outperform a generic skeleton, therefore the application of wide confidence intervals may enable a generic skeleton to be used. Further work is needed to determine the optimum skeleton.

OBJECTIVE: The question of whether depression is associated with worse survival in people with cancer remains unanswered because of methodological criticism of the published research on the topic. We aimed to study the association in a large methodologically robust study. METHODS: We analyzed data on 20,582 patients with breast, colorectal, gynecological, lung, and prostate cancers who had attended cancer outpatient clinics in Scotland, United Kingdom. Patients had completed two-stage screening for major depression as part of their cancer care. These data on depression status were linked to demographic, cancer, and subsequent mortality data from national databases. We estimated the association of major depression with survival for each cancer using Cox regression. We adjusted for potential confounders and interactions between potentially time-varying confounders and the interval between cancer diagnosis and depression screening, and used multiple imputation for missing depression and confounder data. We pooled the cancer-specific results using fixed-effects meta-analysis. RESULTS: Major depression was associated with worse survival for all cancers, with similar adjusted hazard ratios (HRs): breast cancer (HR = 1.42, 95% confidence interval [CI] = 1.15-1.75), colorectal cancer (HR = 1.47, 95% CI = 1.11-1.94), gynecological cancer (HR = 1.36, 95% CI = 1.08-1.71), lung cancer (HR = 1.39, 95% CI = 1.24-1.56), and prostate cancer (HR = 1.76, 95% CI = 1.08-2.85). The pooled HR was 1.41 (95% CI = 1.29-1.54, p < .001, I2 = 0%). These findings were not materially different when we only considered the deaths (90%) that were attributed to cancer. CONCLUSIONS: Major depression is associated with worse survival in patients with common cancers. The mechanisms of this association and the clinical implications require further study.

Objective Depression and anxiety have both been reported to predict worse subsequent survival in people with cancer. However, depression and anxiety are mutually associated and we lack understanding of their independent associations with survival. We therefore aimed to investigate these in a large sample of patients with common cancers. Methods We analysed data on 19,966 patients with common cancers (breast, colorectal, gynaecological, lung and prostate) who had attended specialist NHS outpatient clinics in Scotland, UK. Hospital Anxiety and Depression Scale (HADS) data were linked with demographic, cancer and mortality data. We estimated the independent associations of depression (HADS depression score) and anxiety (HADS anxiety score) with survival by fitting (separately for each cancer) Cox proportional hazards models which incorporated cubic splines to allow for non-linear associations. We also adjusted for potential confounders. Results The median time from HADS completion to death or censoring was 1.9 years. Greater depression was found to be strongly associated with worse survival from all cancers. When adjusted for anxiety, this association remained in males and increased in females. Greater anxiety was also associated with worse survival in nearly all cancers. However, when adjusted for depression, the association of anxiety with worse survival was lost. In females the association reversed direction so that greater anxiety was associated with better survival. Conclusion Although often considered together as aspects of ‘emotional distress’, depression and anxiety have different independent associations with survival in patients with cancer and should therefore be considered separately.

Background: Increased activation of transcription factor CCAAT/enhancer-binding protein β (C/EBPβ) promotes tumor survival and proliferation and inhibits differentiation. ST101 is a therapeutic peptide designed to antagonize C/EBPβ; it penetrates the blood-brain barrier and has anti-tumor activity in multiple human cancer cell lines and animal models. Methods: This was a first-in-human, open-label, phase 1-2 dose-finding study. The primary objective was to evaluate safety and tolerability in patients with cancer. Secondary and exploratory objectives included ST101 pharmacokinetics (PK) and pharmacodynamics (PD). Phase 1 enrolled patients with advanced/metastatic solid tumors refractory or intolerant to all therapeutic options. Patients received ST101 intravenously 0.5, 1, 2, 4, 8 mg/kg QW and 16 mg/kg Q2W in a standard 3+3 design. The recommended phase 2 dose will be further investigated in expansion cohorts of patients with breast cancer, melanoma, glioblastoma, and castration-resistant prostate cancer. Results: As of 01.05.21 9 patients have enrolled into phase 1. Patients received 1-5 prior lines of therapy and had an ECOG status of 0 or 1. PK was predictable and consistent with pre-clinical data. Mean Cmax and AUC(0-t) increased proportionally with increasing dose. Maximum concentrations were observed at the end of 90-minute infusion and mean T1/2 was calculated as 18h and 31h, respectively in Cohort 1 and Cohort 2. Concentrations of ST101 were similar on Days 8 and 15 when compared to Day 1 in each cycle. Immunohistochemistry of tumor samples taken shortly after the 4th infusion from 2/2 patients in Cohort 1 and 1/1 patient in cohort 2 stained positive for ST101. No ST101-related serious adverse events were observed. There were no dose limiting toxicities, dose modifications or withdrawals due to toxicity. Symptoms of infusion related reactions (max grade 2) were reported in five patients and were managed with antihistamine and/or anti-inflammatory prophylaxis and by decreasing the infusion rate. Five patients withdrew due to progression of their cancer. Conclusions: ST101 was safe and well tolerated at the doses and schedule tested, and PK appeared predictable. ST101 was designed to have a prolonged plasma T1/2 and these results confirm preclinical observations, demonstrating a longer than expected T1/2 for a drug of this class. Tumor uptake of ST101 was demonstrated at the lowest dose level. ST101 dose(mg/Kg)CyclenMean Cmax (ng/mL)Mean Tmax (h)Mean AUC(0-t)(h*ng/mL)Mean Tlast (h)Mean AUC(0-inf)(h*ng/mL)Mean T1/2(h)Mean extrapolation(%)0.51316001.59000271500018230.52214001.539006NDNDND0.53211339001.5390007245000311512148001.5180008NDNDND131 Citation Format: Gerald Falchook, Meredith McKean, Nehal Lakhani, Tobias Arkenau, Stefan Symeonides, Jeff Evans, Emerson Lim, Jim Rotolo, Rob Michel, Alice Bexon. Tumor uptake and predictable PK of ST101 - a peptide antagonist of C/EBPβ - in patients with advanced unresectable and metastatic solid tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB114.

Background: The novel ProTide NUC-7738 is a phosphoramidate transformation of 3'-deoxyadenosine (3'-dA or cordycepin), a derivative of adenosine that was first isolated from Cordyceps sinensis. The cytotoxic effect of 3'-dA is largely attributed to intracellular generation of the triphosphate metabolite, 3'-dATP, which inhibits DNA and RNA synthesis. Although 3'-dA has potent in vitro anti-tumor activity, it has not been successful in clinical studies due to its rapid breakdown by adenosine deaminase (ADA). NUC-7738 was designed to overcome the key cancer resistance mechanisms associated with 3'-dA. NUC-7738 is resistant to breakdown by ADA, enters cancer cells independently of the human equilibrative nucleoside transporter (hENT1) and it does not require adenosine kinase for phosphorylation. Methods: NuTide:701 is a two-part, first-in-human Phase I study in patients with advanced solid tumors or lymphoma who have exhausted all standard treatment options. The primary objective is to determine the recommended phase 2 dose (RP2D) and schedule of NUC-7738. Secondary objectives include safety, pharmacokinetics and anti-tumor activity. Part 1, in patients with advanced solid tumors, will establish the RP2D and schedule of NUC-7738. Part 2 will further evaluate NUC-7738 in expansion cohorts of patients with advanced solid tumors or lymphomas. Results: As of 25 Sept 2020, 15 patients had received escalating doses of 14-600 mg/m2 (IV infusion from 30-120 mins) NUC-7738 q1w in Part 1. Patients had received a mean of 3 prior lines of therapy (range: 1 to 5), with melanoma (n=5) and lung (n=3) the most common primary tumor types enrolled. NUC-7738 was well tolerated, with no Grade 3 or 4 treatment-related AEs. No dose-limiting toxicities have been reported. Encouraging signals of anti-cancer activity were observed in three patients who continued to receive clinical benefit for over 6 months (1 patient remained on treatment for over 17 months). NUC-7738 has a predictable plasma PK profile, with a dose proportional increase in Cmax and AUC. High intracellular levels of the anti-cancer metabolite 3'-dATP in PBMCs were detected 2 hours after the start of infusion and maintained for at least 24 hours. Conclusion: NUC-7738 has shown promising anti-cancer activity and a favorable tolerability profile in patients with advanced, treatment-refractory tumors. Patients had high and durable intracellular levels of the anti-cancer metabolite 3'-dATP, supporting non-clinical data that NUC-7738 overcomes the key cancer resistance mechanisms associated with 3'-dA. Citation Format: Ruth Plummer, Farasat Kazmi, Noor Md Haris, Tze-en Ding, Francesca Aroldi, Michelle Myers, Stefan Symeonides, Sarah Blagden. NUC-7738, a novel ProTide transformation of 3′-deoxyadenosine, in patients with advanced solid tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT136.

Objective There is evidence that patients with cancer have worse survival if they have comorbid major depression, but uncertainty whether a reduction in depression severity improves survival. We aimed to address this question. Methods We did a secondary analysis of data from participants in the SMaRT Oncology-2 and 3 trials of depression treatment in patients with cancer and comorbid major depression (total n = 642). Participants' data were analysed as cohorts, defined by treatment (usual care or Depression Care for People with Cancer, an intensive treatment programme, in both trials) and cancer prognosis (good or poor, in SMaRT Oncology-2 and 3 respectively). We measured change in depression severity from randomisation to 12 weeks using Symptom Checklist Depression Scale (SCL-20) scores and assessed survival by linked mortality data. We used Cox regression to estimate the effect of a one-unit decrease in SCL-20 score on survival, controlling for measured confounders. Results We found no evidence for an association between improvement in depression and survival in any of the four cohorts, after adjusting for age, sex, primary cancer, baseline cancer severity and baseline depression severity. Pooling the cohorts in a fixed-effects meta-analysis yielded an estimated 7% reduction in the hazard of death per one-unit decrease in SCL-20 score. This finding was not statistically significant; the 95% confidence interval extended from a 26% decrease to an 18% increase in hazard of death. Conclusion We found no evidence that reduction in severity of comorbid major depression is associated with longer survival in patients with cancer.

348 Background: A subset of patients with metastatic renal cell carcinoma (mRCC) follow an indolent disease course. Given the toxicity and non-curative nature associated with systemic anti-cancer therapy (SACT), some patients may benefit from initial active surveillance (AS). However, selecting patients suitable for this approach is challenging. Biomarkers of systemic inflammation predict survival in mRCC, both independently and as part of the International Metastatic Database Consortium (IMDC) risk score. We sought to use these biomarkers to characterise the time to initiation of SACT (tSACT) in mRCC patients on AS. Methods: 126 mRCC patients clinically assessed and commenced on AS prior to any systemic therapy were retrospectively identified from a regional mRCC clinical database. Patients who underwent metastasectomy for oligometastatic disease at any time were excluded. The primary endpoint, tSACT, was defined as the time from radiological diagnosis of mRCC until SACT initiation, or death, or censorship if continuing AS at follow-up date. Inflammatory biomarkers from routine blood tests (haemoglobin, white cell count, neutrophil count, platelets, C-reactive protein (CRP), albumin) and the IMDC score, measured at the time of diagnosis of mRCC, were recorded. The relationship between these and tSACT was examined using Kaplan-Meier and Cox-regression methods. Results: 66 (52%) patients had commenced SACT. 17 (13.5%) had died without commencing SACT (median survival of the 17 was 40.4 months, range 9.1-130.2 months, and comorbidities may have affected fitness for starting therapy or led to all-cause mortality). 43 patients remained on AS, with minimum and median follow-up of 12.6 months and 39.6 months respectively. The median tSACT was 17.2 months (IQR 8.8-34.8 months). On univariate analysis, CRP and albumin were predictive of time on AS ( p= 0.01 and p= 0.049 respectively). On multivariate analysis, only CRP was independently associated with tSACT ( p= 0.035), stratifying tSACT from 9.1 months (CRP > 10) to 20.9 months (CRP≤10) ( p= 0.009). 111 (88.1%) patients were IMDC 0-1, while 12 (9.5%) and 3 (2.4%) were IMDC 2 or 3 and may have had comorbidities that influenced the initial AS decision. In our cohort the IMDC risk score did not predict time on AS. Conclusions: These results highlight that some patients with mRCC may undergo active surveillance for a marked time period before SACT initiation. We identify routine biomarkers of the systemic inflammatory response that predict time to systemic therapy. In particular CRP, a simple measure of inflammation, stratifies the time to initiation of SACT across a clinically significant time period. This simple, widely available test may help to objectively inform clinical decisions about AS in patients in mRCC. Additional experience is necessary to further define the risks and benefits of this approach.

Introduction: BT1718 is a targeted Bicycle peptide-conjugate designed to deliver the anti-tubulin agent, DM1 to tumors expressing membrane type 1-matrix metalloprotease (MT1-MMP; MMP14; MT1). In vivo preclinical studies demonstrated that anti-tumor activity of BT1718 is dependent on the level of tumor MT1-MMP expression. In patient tumors MT1-MMP expression has been reported in tumor and stromal cells, both of which may contribute to the potential for anti-tumor effects following BT1718 dosing. BT1718 is currently being investigated in a Phase 1/2 clinical trial, which includes both dose escalation (ongoing) and dose expansion cohorts enrolling patients with advanced solid tumors that have exhausted standard therapeutic options. The dose expansion cohorts will enroll patients with tumors expressing high levels of MT1-MMP following establishment of the recommended Phase 2 dose. Here we describe the analysis of TMAs stained using a clinical grade MT1-MMP IHC assay to guide which patient populations to include in BT1718 dose expansion cohorts. Methods: A clinical grade MT1-MMP IHC assay was developed on the Ventana platform using a Millipore MT1-MMP primary antibody (MAB3328) at 1:6000 and detected using Optiview chemistry. Cancer indications reported in the literature with high MT1-MMP expression including ovarian, bladder, triple negative breast, esophageal, and NSCLC were stained and MT1-MMP expression levels estimated by consensus review of two pathologists using an H-score scale (staining intensity*percent positivity). H-scores (0-300) were derived separately for tumor membrane (TM), cytoplasm (TC), and stroma (TS) for each case. Results: MT1-MMP expression in TM/TS, but not TC is likely to yield the greatest potential for BT1718 binding and subsequent anti-tumor activity. Therefore, analyses of TM/TS H-scores were used to identify BT1718 dose expansion cohorts. Histograms were generated separately for TM and TS H-scores with a bin-width of 50. The distribution of MT1-MMP staining in TM and TS was different (Table 1) with H-score between 0-49 being the most frequently populated TM bin, regardless of indication. In contrast, TS scores were typically higher (e.g. H-score=100-149), with the clearest example being ovarian cancer (89% of cases TM 0-49 & only 20% of cases TS 0-49). In addition, within NSCLC, tumor subtype analysis demonstrated that cases of squamous histology appeared enriched for higher TM H-scores (TM≥150=36%) compared to adenocarcinoma cases (TM≥150=2%). Moreover, various TM and/or TS H-score boundaries were modelled with the aim of delivering a proposed cut-off for recruiting patients with high MT1-MMP expression to the expansion cohorts, the results of this modelling will be presented. Table 1: Distribution of MT1-MMP TM and TS H-scores across multiple indications p> Citation Format: Tara Gelb, Chris Bacon, Philip Sloan, Mike Rigby, Stephanie Guerrera, Fiona Kelly, Stefan Symeonides, Stephen J Blakemore. MT1-MMP Immunohistochemistry (IHC) analysis of tumor microarrays (TMAs) using a novel scoring system guides patient selection for BT1718 expansion cohorts [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr A047. doi:10.1158/1535-7163.TARG-19-A047

Background BT1718 contains a constrained bicyclic peptide with high affinity and selectivity for cell surface target MT1-MMP (MMP14) linked to a toxin (DM1) via a cleavable disulphide linker. BT1718 has demonstrated significant anti-tumor activity in preclinical studies in tumors that express MT1-MMP. Following intravenous (IV) administration to preclinical species, BT1718 exhibited PK typical of a BTC. We report clinical progress on QW and BIW dosing, plasma and tumor PK results. Methods This is a first in human, multicenter, dose escalation study in advanced solid tumor pts with the aims of establishing the recommended phase 2 dose (RP2D) for QW & BIW IV BT1718 dosing (3 out of every 4 weeks per cycle), and exploratory PK. Following determination of RP2Ds, expansion cohorts will enroll to further explore efficacy, tolerability and PD of BT1718 in ∼70 pts with MT1-MMP expressing tumors such as NSCLC and TNBC. Results 24 pts were enrolled with various types of solid tumors across both dose escalation cohorts (see table). BIW RP2D was determined as 7.2 mg/m2. The 2 pts with DLTs at 9.6 mg/m2 BIW experienced grade 3 increased GGT or fatigue. QW dose escalation continues at 20 mg/m2. Mean number of cycles received = 2.3 months (N = 24), with no objective responses observed to date in this unselected population. Consistent with preclinical data, preliminary clinical PK results with BT1718 confirm moderate plasma clearance (∼10 mL/min/kg) linear with dose, a volume of distribution similar to extracellular fluid (∼0.20 L/kg) and a t1/2 of ∼0.3 h. Analysis of pts biopsy samples confirms distribution of DM1 in tumors at similar concentrations observed in mouse xenograft models. Results will be updated at time of presentation. Table . 464P BT1718 Dose (mg/m2) Twice weekly schedule (BIW) Once weekly schedule (QW) DLT evaluable pts DLTs DLT evaluable pts DLTs 0.6 1 0 NA NA 1.2 1 0 NA NA 2.4 1 0 NA NA 4.8 1 0 NA NA 7.2 6 0 NA NA 9.6 4 2 3 0 15 NA NA 3 0 20 NA NA 2 0 Conclusions BT1718 is a first in class BTC which is generally well tolerated at the present dose level. Current plasma and tumor PK data are consistent with proposed preclinical mechanism of tumor targeted toxin delivery. Clinical trial identification NCT03486730. Legal entity responsible for the study Cancer Research UK. Funding Cancer Research UK and BicycleRD Limited. Disclosure N. Cook: Advisory / Consultancy: Tarveda Therapeutics; Advisory / Consultancy: Epigene Therapeutics. U. Banerji: Advisory / Consultancy: Astellas; Advisory / Consultancy: Novartis; Advisory / Consultancy: Karus Therapeutics; Advisory / Consultancy: Phoenix ACT; Advisory / Consultancy: Eli Lilly; Advisory / Consultancy: Astex; Advisory / Consultancy: Vernalis; Research grant / Funding (institution), ONX-0801: funding for investigator-initiated Phase I trial: Onyx Pharmaceuticals; Research grant / Funding (institution), ONX-0801: funding for investigator-initiated Phase I trial: BTG International; Research grant / Funding (institution), RAF/MEK: funding for investigator-initiated Phase I trial: Chugai; Research grant / Funding (institution), TAX-TORC: funding for investigator-initiated Phase I trial: AstraZeneca; Research grant / Funding (institution), FRAME: funding for investigator-initiated Phase I trial: Verastem; Full / Part-time employment, ICR is involved in the development of PI3K, HSP90, HDAC, AKT, ROCK, RAF and CHK1: Institute of Cancer Research. J. Evans: Speaker Bureau / Expert testimony: BMS, Eisai, Bayer, Roche, Celgene, MSD; Officer / Board of Directors, Committee Member: Genmab (chair), BMS; Advisory / Consultancy: Karus Therapeutics; Research grant / Funding (self): AstraZeneca, Basliea, BMS, Bayer, Celgene, MSD, MiNa therapeautics, Roche, Medicina, Pfizer, Sierra, Verastem, Lilly, Eisai, NuCana, GSK, Novartis, Immunocore, Bicycle Therapeutics, Haloxyme, Berg, JJ Leadership role, Non-remunerated: Cancer Research UK, NCRN, Breast Cancer Now, Pancreatic Cancer Research Fund, EORTC GI group member, British Council of Cancer, Wales Clinical Trial Unit, ILCA; Non-remunerated activity/ies, Member: BACR, EACT, ACP, ESMO, ASCO, AACR. A. Biondo: Full / Part-time employment, ICR is involved in the development of PI3K, HSP90, HDAC, AKT, ROCK, RAF and CHK1: Institute of Cancer Research. P. Jeffrey: Full / Part-time employment: BicycleRD Limited. M. Rigby: Full / Part-time employment: BicycleRD Limited. G. Bennett: Full / Part-time employment: BicycleRD Limited. S. Blakemore: Full / Part-time employment: BicycleRD Limited. All other authors have declared no conflicts of interest.

Background: Comorbid major depression has been associated with worse survival in patients with cancer. However, we do not know if treating depression improves survival. In the SMaRT Oncology-2 (good prognosis cancers) and SMaRT Oncology-3 (lung cancer, a poor prognosis cancer) trials, we found that a depression treatment programme, Depression Care for People with Cancer (DCPC), was effective in reducing comorbid major depression. In this analysis, we aimed to identify whether DCPC also had an effect on survival.Methods: The trials were conducted in three cancer centres and their associated clinics in Scotland, UK. In SMaRT Oncology-2, outpatients with good prognosis cancers and major depression were randomly assigned in a 1:1 ratio to DCPC or usual care, with stratification (by trial centre) and minimisation (by age, primary cancer, and sex) with allocation concealment. In SMaRT Oncology-3, outpatients with lung cancer and major depression were randomly assigned (1:1 ratio) to DCPC or usual care with stratification (by trial centre) and minimisation (by age, sex, and cancer type) with allocation concealment. For this analysis, we obtained long-term data on deaths (all causes) in the SMaRT Oncology-2 and 3 trial participants, censored at July 31, 2015, and analysed survival as a trial outcome. We estimated unadjusted hazard ratios (HRs) for each trial using Cox regression, and pooled the log HRs in a fixed-effects meta-analysis.Findings: We recruited 642 participants; between May 12, 2008, and May 13, 2011, 500 participants were recruited to the SMaRT Oncology-2 trial and between Jan 5, 2009, and Sept 9, 2011, 142 participants were recruited to the SMaRT Oncology-3 trial. We followed up SMaRT Oncology-2 and SMaRT Oncology-3 participants for a median of 5 years and 1 year, respectively. 135 (27%) of 500 SMaRT Oncology-2 participants and 114 (80%) of 142 SMaRT Oncology-3 participants died within this period. We found no significant effect of DCPC on survival in the total follow-up period for either SMaRT Oncology 2 (HR 1·02, 95% CI 0·72–1·42, p=0·93) or SMaRT Oncology-3 (HR 0·82, 95% CI 0·56–1·18, p=0·28; pooled HR 0·92, 95% CI 0·72–1·18, p=0·51).Interpretation: DCPC is highly effective in improving depression and quality of life in depressed patients with cancer, but there was no evidence for a significant effect on survival. Despite the absence of an effect on length of life, the management of depression remains important for its beneficial effect on quality of life.Funding: NIHR CLAHRC Oxford, Cancer Research UK, and the Chief Scientist Office of the Scottish Government.

Background The continual reassessment method (CRM) requires an underlying model of the dose-toxicity relationship (“prior skeleton”) and there is limited guidance of what this should be when little is known about this association. In this manuscript the impact of applying the CRM with different prior skeleton approaches and the 3 + 3 method are compared in terms of ability to determine the true maximum tolerated dose (MTD) and number of patients allocated to sub-optimal and toxic doses. Methods Post-hoc dose-escalation analyses on real-life clinical trial data on an early oncology compound (AZD3514), using the 3 + 3 method and CRM using six different prior skeleton approaches. Results All methods correctly identified the true MTD. The 3 + 3 method allocated six patients to both sub-optimal and toxic doses. All CRM approaches allocated four patients to sub-optimal doses. No patients were allocated to toxic doses from sigmoidal, two from conservative and five from other approaches. Conclusions Prior skeletons for the CRM for phase 1 clinical trials are proposed in this manuscript and applied to a real clinical trial dataset. Highly accurate initial skeleton estimates may not be essential to determine the true MTD, and, as expected, all CRM methods out-performed the 3 + 3 method. There were differences in performance between skeletons. The choice of skeleton should depend on whether minimizing the number of patients allocated to suboptimal or toxic doses is more important. Trial registration NCT01162395, Trial date of first registration: July 13, 2010. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2702-6) contains supplementary material, which is available to authorized users.

e16578Background: The randomised phase III METEOR trial showed survival benefit of cabozantinib over everolimus in patients with mRCC who progressed after VEGF targeted therapy. We report real worl...

Summary Background Major depression is an important complication of cancer. However, reliable data are lacking for the prevalence of depression in patients with cancer in different primary sites, the association of depression with demographic and clinical variables within cancer groupings, and the proportion of depressed patients with cancer receiving potentially effective treatment for depression. We investigated these questions with data from a large representative clinical sample. Methods We analysed data from patients with breast, lung, colorectal, genitourinary, or gynaecological cancer who had participated in routine screening for depression in cancer clinics in Scotland, UK between May 12, 2008, and Aug 24, 2011. Depression screening was done in two stages (first, Hospital Anxiety and Depression Scale; then, major depression section of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition). Data for depression status were linked with demographic and clinical data obtained from the Scottish National Cancer Registry. Findings We analysed data for 21 151 patients. The prevalence of major depression was highest in patients with lung cancer (13·1%, 95% CI 11·9–14·2%), followed by gynaecological cancer (10·9%, 9·8–12·1), breast cancer (9·3%, 8·7–10·0), colorectal cancer (7·0%, 6·1–8·0), and genitourinary cancer (5·6%, 4·5–6·7). Within these cancer groupings, a diagnosis of major depression was more likely in patients who were younger, had worse social deprivation scores, and, for lung cancer and colorectal cancer, female patients. 1130 (73%) of 1538 patients with depression and complete patient-reported treatment data were not receiving potentially effective treatment. Interpretation Major depression is common in patients attending cancer clinics and most goes untreated. A pressing need exists to improve the management of major depression for patients attending specialist cancer services. Funding Cancer Research UK and Chief Scientist Office of the Scottish Government.