1. Immunotherapeutic maintenance treatment with toll-like receptor 9 agonist lefitolimod in patients with extensive-stage small-cell lung cancer: results from the exploratory, controlled, randomized, international phase II IMPULSE study
- Author
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Oliver Schmalz, K.-P. Fröhling, E. Wiegert, Martin Wolf, Rumo Leistner, Wolfgang Blau, Hans-Georg Kopp, C. Wesseler, Claudia Mauri, W. M. Brückl, Christian Herzmann, Jens Kollmeier, Kerstin Kapp, Veerle Surmont, Parvis Sadjadian, Monika Serke, Michael Thomas, A. Navarro, M. Domine Gomez, Christian Brandts, Burghardt Wittig, Yolanda Garcia Garcia, Christina Grah, Lothar Müller, Georg Pall, Maria Rosario Garcia Campelo, Santiago Ponce-Aix, Frank Griesinger, J. Riera-Knorrenschild, Michael Schmidt, José Manuel Trigo Perez, Michael Schröder, A. Meyer, Léon Bosquee, Christian Wilfried Scholz, Rudolf M. Huber, and Paul Germonpré
- Subjects
0301 basic medicine ,Oncology ,medicine.medical_specialty ,Lung Neoplasms ,Thoracic Tumors ,Population ,lefitolimod ,law.invention ,Carboplatin ,Maintenance Chemotherapy ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Maintenance therapy ,Randomized controlled trial ,law ,TLR9 agonist ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Lung cancer ,education ,Survival rate ,Etoposide ,education.field_of_study ,business.industry ,Hazard ratio ,Cancer ,International Agencies ,SCLC ,Hematology ,Original Articles ,medicine.disease ,Prognosis ,Chemotherapy regimen ,Small Cell Lung Carcinoma ,Survival Rate ,030104 developmental biology ,030220 oncology & carcinogenesis ,Toll-Like Receptor 9 ,immunotherapy ,Cisplatin ,business ,Immunosuppressive Agents ,Leflunomide ,Follow-Up Studies - Abstract
Background The immune surveillance reactivator lefitolimod (MGN1703), a DNA-based TLR9 agonist, might foster innate and adaptive immune response and thus improve immune-mediated control of residual cancer disease. The IMPULSE phase II study evaluated the efficacy and safety of lefitolimod as maintenance treatment in extensive-stage small-cell lung cancer (ES-SCLC) after objective response to first-line chemotherapy, an indication with a high unmet medical need and stagnant treatment improvement in the last decades. Patients and methods 103 patients with ES-SCLC and objective tumor response (as per RECIST 1.1) following four cycles of platinum-based first-line induction therapy were randomized to receive either lefitolimod maintenance therapy or local standard of care at a ratio of 3 : 2 until progression or unacceptable toxicity. Results From 103 patients enrolled, 62 were randomized to lefitolimod, 41 to the control arm. Patient demographics and response patterns to first-line therapy were balanced. Lefitolimod exhibited a favorable safety profile and pharmacodynamic assessment confirmed the mode-of-action showing a clear activation of monocytes and production of interferon-gamma-induced protein 10 (IP-10). While in the intent-to-treat (ITT) population no relevant effect of lefitolimod on progression-free and overall survival (OS) could be observed, two predefined patient subgroups indicated promising results, favoring lefitolimod with respect to OS: in patients with a low frequency of activated CD86+ B cells (hazard ratio, HR 0.53, 95% CI: 0.26–1.08; n = 38 of 88 analyzed) and in patients with reported chronic obstructive pulmonary disease (COPD) (HR 0.48, 95% CI: 0.20–1.17, n = 25 of 103). Conclusions The IMPULSE study showed no relevant effect of lefitolimod on the main efficacy end point OS in the ITT, but (1) the expected pharmacodynamic response to lefitolimod, (2) positive OS efficacy signals in two predefined subgroups and (3) a favorable safety profile. These data support further exploration of lefitolimod in SCLC.
- Published
- 2018