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Defactinib, Pembrolizumab, and Gemcitabine in Patients with Advanced Treatment Refractory Pancreatic Cancer: A Phase I Dose Escalation and Expansion Study.


ABSTRACT:

Purpose

Targeting focal adhesion kinase (FAK) renders checkpoint immunotherapy effective in pancreatic ductal adenocarcinoma (PDAC) mouse model. Defactinib is a highly potent oral FAK inhibitor that has a tolerable safety profile.

Patients and methods

We conducted a multicenter, open-label, phase I study with dose escalation and expansion phases. In dose escalation, patients with refractory solid tumors were treated at five escalating dose levels of defactinib and gemcitabine to identify a recommended phase II dose (RP2D). In expansion phase, patients with metastatic PDAC who progressed on frontline treatment (refractory cohort) or had stable disease (SD) after at least 4 months of standard gemcitabine/nab-paclitaxel (maintenance cohort) were treated at RP2D. Pre- and posttreatment tumor biopsies were performed to evaluate tumor immunity.

Results

The triple drug combination was well-tolerated, with no dose-limiting toxicities. Among 20 treated patients with refractory PDAC, the disease control rate (DCR) was 80%, with one partial response (PR) and 15 SDs, and the median progression-free survival (PFS) and overall survival (OS) were 3.6 and 7.8 months, respectively. Among 10 evaluable patients in the maintenance cohort, DCR was 70% with one PR and six SDs. Three patients with SD came off study due to treatment- or disease-related complications. The median PFS and OS on study treatment were 5.0 and 8.3 months, respectively.

Conclusions

The combination of defactinib, pembrolizumab, and gemcitabine was well-tolerated and safe, had promising preliminary efficacy, and showed biomarker activity in infiltrative T lymphocytes. Efficacy of this strategy may require incorporation of more potent chemotherapy in future studies.

SUBMITTER: Wang-Gillam A 

PROVIDER: S-EPMC9772237 | biostudies-literature | 2022 Dec

REPOSITORIES: biostudies-literature

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Publications

Defactinib, Pembrolizumab, and Gemcitabine in Patients with Advanced Treatment Refractory Pancreatic Cancer: A Phase I Dose Escalation and Expansion Study.

Wang-Gillam Andrea A   Lim Kian-Huat KH   McWilliams Robert R   Suresh Rama R   Lockhart Albert C AC   Brown Amberly A   Breden Marcus M   Belle Jad I JI   Herndon John J   Bogner Savannah J SJ   Pedersen Katrina K   Tan Benjamin B   Boice Nicholas N   Acharya Abhi A   Abdiannia Mina M   Gao Feng F   Yoon Harry H HH   Zhu Mojun M   Trikalinos Nikolaos A NA   Ratner Lee L   Aranha Olivia O   Hawkins William G WG   Herzog Brett H BH   DeNardo David G DG  

Clinical cancer research : an official journal of the American Association for Cancer Research 20221201 24


<h4>Purpose</h4>Targeting focal adhesion kinase (FAK) renders checkpoint immunotherapy effective in pancreatic ductal adenocarcinoma (PDAC) mouse model. Defactinib is a highly potent oral FAK inhibitor that has a tolerable safety profile.<h4>Patients and methods</h4>We conducted a multicenter, open-label, phase I study with dose escalation and expansion phases. In dose escalation, patients with refractory solid tumors were treated at five escalating dose levels of defactinib and gemcitabine to i  ...[more]

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