Article

Register trial of sorafenib (S) for patients (pts) with metastatic uveal melanoma (metUvMel)

Authors:
  • KMG Klinik Silbermühle GmbH
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Abstract

s: AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics--Nov 12-16, 2011; San Francisco, CA Background: There is no effective systemic therapy for patients (pts) with metastatic uveal melanoma (metUvMel). Due to the paucity of clinical trials pts are frequently offered individual treatment options. We have analyzed the outcome of pts treated for metUvMel with the oral multikinase inhibitor sorafenib (S) in an IEC-approved register trial of the West German Cancer Center, a national reference center for uveal melanomas. Methods: Pts with metUvMel were treated with S [at a dose of 400 mg bid in the first group (G1) and of 200 mg bid in the second group (G2)]. Overall survival (OS) and time to symptomatic progression (TTPsymp) were studied as primary outcome parameters. Secondary outcomes included time to radiologic progression (TTPrad) according to CT and safety. In addition, digital contrast-enhanced NMR (DCE-NMR) and contrast-enhanced ultrasound (CEUS) of liver metastases were performed in selected pts. Results: A total of 62 pts (median age 63 yrs, range 35–83 yrs; 31 female [50%], 31 male [50%], ECOG 0 44 pts [71%], ECOG 1 15 pts [26%], ECOG 2 2 pts [3%]) were included in the analysis on an intent to treat basis (ITT). Fortysix pts had no prior systemic treatment (74%). Metastatic sites included liver in 60 pts (97%) in addition to other organs in 20 pts (32%). Only two pts (3%) had exclusively extrahepatic metastases. Following 4 CTC-Grade 4 toxicities [hand-foot-syndrome (HFS) and/or diarrhea] in the first 31 pts (G1) (13%), the starting dose of S was reduced to 200 mg twice daily in the subsequent 31 pts (G2) effectively preventing further severe side effects. Median OS was 10.8 mths (CI 6.1–15.1 mths) in G1 and 14.0 mths (CI 6.4-nd mths) in G2, median TTPrad was 5.0 mths (CI 3.1–8.9 mths) in G1 and 4,5 mths (CI 1.5–6.0 mths) in G2 and TTPsymp was 4.1 mths (CI 3.1–5.2 mths) in G1 and 7.1 mths (CI 3.2–10.6 mths) in G2 (Wilcoxon 0.043), respectively. Conclusions: S at a dose of 200 mg bid is safe in pts with metUvMel predominantly metastatic to the liver and seems to be effective with a median OS of more than 10 mths. Treatment results are encouraging in an orphan malignant disease without established palliative systemic treatment options. A multicenter randomized discontinuation trial with S in pts with metUvMel will be performed. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2011 Nov 12-16; San Francisco, CA. Philadelphia (PA): AACR; Mol Cancer Ther 2011;10(11 Suppl):Abstract nr C185.

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... Of 59 retrieved articles including 11 congress abstracts, four were excluded because of small patient numbers (n < 4) [8][9][10] or ecological design [2]. Nine were excluded because ORR was not reported [11][12][13][14][15] or mixture study design did not permit separate analysis of MUM data [16][17][18][19]. Forty-six studies were included in review discussion, that is, one case series, five pilot, three phase I, one phase I/II, 29 phase II, and one phase III study, data from three expanded access programs, and four retrospective data analyses. ...
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Up to 50% of patients with uveal melanoma develop metastatic disease with poor prognosis. Regional, mainly liver-directed, therapies may induce limited tumor responses but do not improve overall survival. Response rates of metastatic uveal melanoma (MUM) to systemic chemotherapy are poor. Insights into the molecular biology of MUM recently led to investigation of new drugs. In this study, to compare response rates of systemic treatment for MUM we searched Pubmed/Web of Knowledge databases and ASCO website (1980-2013) for "metastatic/uveal/melanoma" and "melanoma/eye." Forty studies (one case series, three phase I, five pilot, 22 nonrandomized, and two randomized phase II, one randomized phase III study, data of three expanded access programs, three retrospective studies) with 841 evaluable patients were included in the numeric outcome analysis. Complete or partial remissions were observed in 39/841 patients (overall response rate [ORR] 4.6%; 95% confidence intervals [CI] 3.3-6.3%), no responses were observed in 22/40 studies. Progression-free survival ranged from 1.8 to 7.2, median overall survival from 5.2 to 19.0 months as reported in 21/40 and 26/40 studies, respectively. Best responses were seen for chemoimmunotherapy (ORR 10.3%; 95% CI 4.8-18.7%) though mainly in first-line patients. Immunotherapy with ipilimumab, antiangiogenetic approaches, and kinase inhibitors have not yet proven to be superior to chemotherapy. MEK inhibitors are currently investigated in a phase II trial with promising preliminary data. Despite new insights into genetic and molecular background of MUM, satisfying systemic treatment approaches are currently lacking. Study results of innovative treatment strategies are urgently awaited.
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