Entrectinib has been granted a priority review designation by the FDA as a therapy for select adult and pediatric patients with <em>NTRK</em> fusion–positive locally advanced or metastatic solid tumors, as well as patients with metastatic <em>ROS1</em>-positive non–small cell lung cancer, according to Genentech, the developer of the multikinase inhibitor.
Sandra Horning, MD
Entrectinib has been granted a priority review designation by the FDA as a therapy for select adult and pediatric patients withNTRKfusionpositive locally advanced or metastatic solid tumors, as well as patients with metastaticROS1-positive nonsmall cell lung cancer (NSCLC), Genentech, the developer of the multikinase inhibitor, has announced.1
Entrectinib would be indicated for patients withNTRKfusionpositive tumors who have either progressed following prior therapies or as initial treatment when no standard acceptable therapies are available. The FDA is expected to decide on the application by August 18, 2019, under the Prescription Drug User Fee Act.
The new drug application is based on findings from an integrated analysis of the phase II STARTRK-2, phase I STARTRK-1, and the phase I ALKA-372-001 trials, which demonstrated a 57.4% overall response rate (ORR) in patients withNTRKfusionpositive solid tumors and a median duration of response (DOR) of 10.4 months.2The application is also based on results from the phase I/Ib STARTRK-NG study. The trials enrolled patients across 15 countries and 150 clinical trial sites.
“Entrectinib represents a unique approach to cancer treatment that can potentially target a range of hard-to-treat and rareNTRKfusionpositive tumors regardless of their site of origin, as well as treatROS1-positive non¬small cell lung cancer,” said Sandra Horning, MD, chief medical officer and head of Global Product Development, Genentech (Roche), the developer of entrectinib. “By combining comprehensive genomic profiling with actionable targeted therapies, like entrectinib, we are advancing our personalized healthcare goal to find the right treatment for each patient. We are working closely with the FDA to make this potential new option available as soon as possible."
The integrated analysis included data of 53 patients withROS1-activating gene fusions and 54 patients with locally advanced or metastaticNTRKfusion¬positive solid tumors from the phase II STARTRK-2, phase I STARTRK-1 and phase I ALKA-372-001 trialscomprising 10 tumor types with more than 19 histopathologies. Tumor types included breast cancer, cholangiocarcinoma, colorectal cancer, gynecological cancer, neuroendocrine tumors, NSCLC, salivary gland cancer, pancreatic cancer, sarcoma and thyroid cancer.
The 54 patients withNTRKfusion-positive tumors had a median age of 57.5, and women accounted for almost 60% of the patients. More than 40% of the patients had received ≥2 or more prior lines of therapy, and 37% had untreated cancers.
In the international, multicenter, open-label, ongoing phase II STARTRK-2 basket trial (NCT02568267), investigators are enrolling 300 patients with solid tumors that harbored anNTRK1-/2-/3-,ROS1-orALK-positive gene fusion. The primary endpoint is ORR; secondary endpoints include DOR, time to response, clinical benefit rate, intracranial tumor response, progression-free survival (PFS), central nervous system (CNS) PFS, and overall survival (OS).
The multicenter, open-label, dose-escalation, phase I STARTRK-1 trial (NCT02097810) evaluated a daily continuous dosing schedule of entrectinib in patients with solid tumors withNTRK1/2/3,ROS1orALKgene fusions in the United States and South Korea. Investigators evaluated the safety and tolerability of entrectinib via a standard dose escalation and determined the recommended phase II dose of entrectinib to be 400 mg/m2daily.
Third, the multicenter, open-label, dose-escalation, phase I ALKA-372-001 study (NCT02097810) evaluated an intermittent and continuous entrectinib dosing schedule in patients in Italy with advanced or metastatic solid tumors withTRKA/B/C,ROS1orALKgene fusions.
Finally, the phase I/Ib dose-escalation and dose-expansion STARTRK-NG study is investigating the safety and efficacy of entrectinib in pediatric and adolescent patients with no curative first-line treatment option, recurrent or refractory extracranial solid tumors or primary CNS tumors, with or withoutTRK, ROS1orALKfusions.
Results from the integrated analysis showed that the responses were observed across 10 solid tumor types, including in patients with and without CNS metastases at baseline. Moreover, the intracranial ORR (IC ORR) was 54.5%, with more than one-quarter of these patients achieving a complete response.
The responses were consistent in several subgroup analyses, including CNS metastases at baseline (50.0%, n=12) versus none (59.5%, n=42); andNTRKgene typeNTRK1(59.1%, n=22), NTRK2 (0%, n=1), andNTRK3(58.1%, n=31). Furthermore, the median PFS was 11.2 months and the median OS was 20.9 months.
Additionally, the pooled findings from STARTRK-2, STARTRK-1, and ALKA-372-001, showed that entrectinib demonstrated a 77.4% ORR and a median DOR of 24.6 months in patients locally advanced or metastaticROS1-positive NSCLC; the IC ORR was 55.0%.
Regarding safety, adverse events (AEs) with entrectinib was consistent with that seen in prior studies. The most commonly reported AEs included fatigue, constipation, dysgeusia, edema, dizziness, diarrhea, nausea, dysesthesia, dyspnea, pain, anemia, cognitive disorders, weight increased, vomiting, cough, blood creatinine increase, arthralgia, pyrexia, and myalgia.
Results of the STARTRK-NG trial were presented at the 2018 ASCO Annual Meeting, demonstrating that 3 pediatric and young adult patients with advanced, previously treated CNS tumors with targeted gene fusionsDCTN1-ALKinflammatory myofibroblastic tumors (IMT),TFG-ROS1IMT, andEML4-NTRK3infantile fibrosarcomaresponded to entrectinib.3Based on these data, investigators identified the recommended phase II dose for children, adolescents, and young adults with solid tumors at 550 mg/m2of daily entrectinib.