ONCAlert | 2018 Gastrointestinal Cancers Symposium

Setback for Abiraterone Acetate in Recurrent Ovarian Cancer

Published Online: 11:30 AM, Wed October 12, 2016

Susanna Banerjee, PhD

Although one patient with recurrent ovarian cancer achieved complete response, the first trial of abiraterone conducted in ovarian cancer was halted early due to low response, according to results from the CORAL phase 2 trial presented at the European Society of Medical Oncology Congress.
The response rate at 12 weeks was 2.4% in the overall study cohort and 3.4% in patients expressing the androgen receptor (AR). However, abiraterone demonstrated activity in one patient who achieved complete response (CR) and remains on treatment. Furthermore, 11 patients showed clinical benefit at 12 weeks that was prolonged to 24 weeks in 4 patients. 
"Abiraterone is a CYP17 inhibitor of androgen biosynthesis that has been approved by the FDA for the treatment of prostate cancer. Androgens bind to the androgen receptor, which is reported to be expressed in up to 90% of epithelial ovarian cancer cases," Susanna Banerjee, PhD, Medical Oncologist at Royal Marsden NHS Foundation Trust, London, UK. "The efficacy of anti-androgens tested so far in ovarian cancer is limited, although abiraterone has been successfully developed in prostate cancer and there are studies in breast cancer," she continued, "There is a rationale for evaluating anti-androgen approaches in ovarian cancer.”
“There is an urgent need to develop smarter treatment options for women with recurrent epithelial ovarian cancer,” she said.
Banerjee and colleagues conducted the CORAL phase II trial in 42 patients with a median age of 64 (Range, 34-85) years with epithelial ovarian cancer who had progressed within 12 months of the last systemic therapy; of these, 88% had high-grade serous histology. The patients had not received prior hormonal anticancer agents, but 47% had received 3 or more previous lines of therapy. The median time from diagnosis was 2.8 years. All patients were administered abiraterone acetate at 1,000 mg plus 5 mg prednisone daily until disease progression or end of study. 
The primary endpoint was the overall response rate (ORR) according to combined RECIST/Gynecological Cancer Intergroup criteria at 12 weeks and the secondary endpoint was the clinical benefit rate (CBR) at 12 weeks.
Tissue and blood samples were obtained to determine hormone receptor status; at baseline, 29 (69%) patients were positive for AR expression, 35 (83.3%) were positive for the estrogen receptor (ER), and 25 (59.5%) patients were positive for the progesterone receptor (PgR).
“For some patients, abiraterone showed activity in ovarian cancer,” Banerjee added. “One patient developed a response, a patient with low-grade serous histology, a subtype that is known to be difficult to treat. Further work on the significance of androgen receptor pathway in epithelial ovarian cancer may warrant further investigation, perhaps in low-grade serous histology.” This patient was AR positive had low-grade serous histology, and achieved a CR that lasted for 47 weeks.
“The clinical benefit was not limited to androgen receptor positive disease only,” Dr. Banerjee noted. The CBR was 26% in the intent-to-treat population and 28% in AR positive patients. Four AR positive patients achieved stable disease lasting for at least 6 months.
Treatment emergent adverse events (TEAEs) Grade 3/4 included hypertension, which occurred in 29% of patients, and hypokalemia in 10%. Dose delays were required in 23% of patients lasting for an average of 7.6 days. 
Treatment discontinuation due to disease progression was reported for 78% of patients, 3 patients also choose to discontinue treatment, and 3 discontinuations occurred for other reasons.
“This is the first trial of abiraterone in ovarian cancer,” Banerjee said. “The desired level of activity was not observed, leading to early trial closure. But, 42 patients were recruited, and hopefully we will be able to derive more information on why some of the patients had clinical benefit by looking at their tumor and blood samples,” Banerjee said.
Banerjee S, Kilburn L, Bowen R, et al. Principal results of the cancer of the ovary abiraterone trial (CORAL): A phase II study of abiraterone in patients with recurrent epithelial ovarian cancer. Presented at: 2016 ESMO Congress; October 7-11 2016; Copenhagen, Denmark. Abstract LBA33

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