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Ripretinib in patients with advanced gastrointestinal stromal tumours (INVICTUS): a double-blind, randomised, placebo-controlled, phase 3 trial

Authors :
Hans Gelderblom
Michael Heinrich
Patrick Schöffski
Sebastian Bauer
Gina Z. D'Amato
Robin L. Jones
Suzanne George
John Zalcberg
Steven Attia
Peter Reichardt
Jean-Yves Blay
K. Shi
Ping Chi
Rodrigo Ruiz-Soto
César Serrano
Margaret von Mehren
Julie Meade
Centre Léon Bérard [Lyon]
UNICANCER
Université Claude Bernard Lyon 1 (UCBL)
Université de Lyon
Vall d'Hebron Institute of Oncology [Barcelone] (VHIO)
Vall d'Hebron University Hospital [Barcelona]
Department of Medicine
University of Washington [Seattle]
Oregon Health and Science University [Portland] (OHSU)
Alfred Health
West German Cancer Center [Essen, Germany]
German Cancer Consortium [Heidelberg] (DKTK)
Leiden University Medical Center (LUMC)
Royal Marsden NHS Foundation Trust
Mayo Clinic
Helios Klinikum Krefeld - Helios Klinikum Krefeld
Dana-Farber Cancer Institute [Boston]
Fox Chase Cancer Center
Source :
Lancet Oncology, Lancet Oncology, Elsevier, 2020, 21, pp.923-934. ⟨10.1016/S1470-2045(20)30168-6⟩, The Lancet Oncology, 21(7), 923-934. ELSEVIER SCIENCE INC
Publication Year :
2019

Abstract

Background Resistance to approved inhibitors of KIT proto-oncogene, receptor tyrosine kinase (KIT), and platelet-derived growth factor receptor alpha (PDGFRA) is a clinical challenge for patients with advanced gastrointestinal stromal tumours. We compared the efficacy and safety of ripretinib, a switch-control tyrosine kinase inhibitor active against a broad spectrum of KIT and PDGFRA mutations, with placebo in patients with previously treated, advanced gastrointestinal stromal tumours.Methods In this double-blind, randomised, placebo-controlled, phase 3 study, we enrolled adult patients in 29 specialised hospitals in 12 countries. We included patients aged 18 years or older who had advanced gastrointestinal stromal tumours with progression on at least imatinib, sunitinib, and regorafenib or documented intolerance to any of these treatments despite dose modifications, and who had an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2. Eligible patients were randomly assigned (2:1) to receive either oral ripretinib 150 mg once daily (ripretenib group) or placebo once daily (placebo group). Randomisation was done via an interactive response system using randomly permuted block sizes of six and stratified according to number of previous therapies and ECOG performance status. Patients, investigators, research staff, and the sponsor study team were masked to a patient's treatment allocation until the blinded independent central review (BICR) showed progressive disease for the patient. The primary endpoint was progression-free survival, assessed by BICR. The primary analysis was done in the intention-to-treat population and safety was assessed in patients who received at least one dose of study drug. Patients randomly assigned to placebo were permitted to cross over to ripretinib 150 mg at the time of disease progression. The INVICTUS study is registered with ClinicalTrials.gov , number NCT03353753, and with WHO International Clinical Trials Registry Platform, number EUCTR2017-002446-76-ES; follow-up is ongoing.Findings Between Feb 27, 2018, and Nov 16, 2018, 129 of 154 assessed patients were randomly assigned to receive either ripretinib (n=85) or placebo (n=44). At data cutoff (May 31, 2019), at a median follow-up of 6.3 months (IQR 3. 2-8. 2) in the ripretinib group and 1.6 months (1.1-2.7) in the placebo group, 51 patients in the ripretinib group and 37 in the placebo group had had progression-free survival events. In the double-blind period, median progression-free survival was 6.3 months (95% CI 4.6-6.9) with ripretinib compared with 1.0 months (0.9-1.7) with placebo (hazard ratio 0.15, 95% CI 0.09-0.25; p2%) grade 3 or 4 treatment-related treatment-emergent adverse events in the ripretinib group (n=85) included lipase increase (four [5%]), hypertension (three [4%]), fatigue (two [2%]), and hypophosphataemia (two [2%]); in the placebo group (n=43), the most common (>2%) grade 3 or 4 treatment-related treatment-emergent adverse events were anaemia (three [7%]), fatigue (one [2%]), diarrhoea (one [2%]), decreased appetite (one [2%]), dehydration (one [2%]), hyperkalaemia (one [2%]), acute kidney injury (one [2%]), and pulmonary oedema (one [2%]). Treatment-related serious adverse events were reported in eight (9%) of 85 patients who received ripretinib and three (7%) of 43 patients who received placebo. Treatment-related deaths occurred in one patient in the placebo group (septic shock and pulmonary oedema) and one patient in the ripretinib group (cause of death unknown; the patient died during sleep).Interpretation Ripretinib significantly improved median progression-free survival compared with placebo and had an acceptable safety profile in patients with advanced gastrointestinal stromal tumours who were resistant to approved treatments. Copyright (C) 2020 Elsevier Ltd. All rights reserved.

Details

ISSN :
14745488, 03353753, and 14702045
Volume :
21
Issue :
7
Database :
OpenAIRE
Journal :
The Lancet. Oncology
Accession number :
edsair.doi.dedup.....0c32eb9e2092ad5fe5412d18290192f0
Full Text :
https://doi.org/10.1016/S1470-2045(20)30168-6⟩