A phase II study of single-agent RO4929097, a gamma-secretase inhibitor of Notch signaling, in patients with recurrent platinum-resistant epithelial ovarian cancer: A study of the Princess Margaret, Chicago and California phase II consortia.

Abstract

PURPOSE:

A phase II study was performed to evaluate the efficacy and safety of single-agent RO4929097 (a gamma-secretase inhibitor) in patients with recurrent platinum-resistant ovarian cancer.

EXPERIMENTAL DESIGN:

Women with progressive platinum-resistant ovarian cancer treated with ≤2 chemotherapy regimens for recurrent disease were enrolled in this trial. Patients received oral RO4929097 at 20 mg once daily, 3 days on/4 days off each week in a three week cycle. The primary endpoint was progression-free survival (PFS) rate at the end of 4 cycles. Secondary objectives included assessment of the safety of RO4929097 and exploration of molecular correlates of outcome in archival tumor tissue and serum.

RESULTS:

Of 45 patients enrolled, 40 were evaluable for response. Thirty-seven (82%) patients had high-grade ovarian cancer. No objective responses were observed. Fifteen patients (33%) had stable disease as their best response, with a median duration of 3.1 months. The median PFS for the whole group was 1.3 months (1.2-2.5). Treatment was generally well tolerated with 10% of patients discontinuing treatment due to an adverse event. In high grade serous ovarian cancer patients, the median PFS trended higher when the expression of intracellular Notch (NICD) protein by immunohistochemistry was high versus low (3.3 versus 1.3 months, p=0.09). No clear relationship between circulating angiogenic factors and PFS was found despite a suggestion of an improved outcome with higher baseline VEGFA levels.

CONCLUSIONS:

RO4929097 has insufficient activity as a single-agent in platinum-resistant ovarian cancer to warrant further study as monotherapy. Future studies are needed to explore the potential for cohort enrichment using NICD expression.

• Authors: Ivan Diaz-Padilla, Michelle K Wilson, Blaise A Clarke, Hal W Hirte, Stephen A Welch, Helen J Mackay, Jim J Biagi, Michael Reedijk, Johanne I Weberpals, Gini F Fleming, Lisa Wang, Geoffrey Liu, Chen Zhou, Chantale Blattler, S Percy Ivy, Amit M Oza
• Journal: Gynecologic oncology (Gynecol Oncol) Vol. 137 Issue 2 Pg. 216-22 (May 2015) ISSN: 1095-6859 [Electronic] United States
• PMID: 25769658 (Publication Type: Clinical Trial, Phase II, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015. Published by Elsevier Inc.

Chemical References

• Benzazepines
• Biomarkers, Tumor
• Enzyme Inhibitors
• Receptors, Notch
• Amyloid Precursor Protein Secretases
• 2,2-dimethyl-N-(6-oxo-6,7-dihydro-5H-dibenzo(b,d)azepin-7-yl)-N'-(2,2,3,3,3-pentafluoropropyl)malonamide

Topics

• Administration, Oral
• Adult
• Aged
• Aged, 80 and over
• Amyloid Precursor Protein Secretases (antagonists & inhibitors)
• Benzazepines (adverse effects, therapeutic use)
• Biomarkers, Tumor (metabolism)
• California
• Carcinoma, Ovarian Epithelial
• Chicago
• Disease-Free Survival
• Enzyme Inhibitors (adverse effects, therapeutic use)
• Female
• Humans
• Middle Aged
• Neoplasms, Glandular and Epithelial (drug therapy, metabolism, pathology)
• Neoplastic Stem Cells (drug effects, metabolism)
• Ontario
• Ovarian Neoplasms (drug therapy, metabolism, pathology)
• Receptors, Notch (metabolism)
• Signal Transduction