TY - JOUR
T1 - Enfortumab vedotin after PD-1 or PD-L1 inhibitors in cisplatin-ineligible patients with advanced urothelial carcinoma (EV‑201): a multicentre, single-arm, phase 2 trial
AU - Yu, Evan Y.
AU - Petrylak, Daniel P.
AU - O'Donnell, Peter H.
AU - Lee, Jae-Lyun
AU - van der Heijden, Michiel S.
AU - Loriot, Yohann
AU - Stein, Mark N.
AU - Necchi, Andrea
AU - Kojima, Takahiro
AU - Harrison, Michael R.
AU - Hoon Park, Se
AU - Quinn, David I.
AU - Heath, Elisabeth I.
AU - Rosenberg, Jonathan E.
AU - Steinberg, Joyce
AU - Liang, Shang-Ying
AU - Trowbridge, Janet
AU - Campbell, Mary
AU - McGregor, Bradley
AU - Balar, Arjun V.
N1 - Funding Information: Funding for this study was provided by Seagen and Astellas Pharma Global Development Inc. Medical writing and editorial support were provided by Sarah Canestaro (Seagen) and Jennifer Secula and William Wilkison (MMS Holdings). Funding Information: EYY reports grants from Seagen during the study; personal fees from Amgen, Clovis, AstraZeneca, Janssen, Advanced Accelerator Applications, Sanofi, Abbvie, Incyte, and QED; grants and personal fees from Bayer, Dendreon, Merck, Pharmacyclics, Seagen; and grants from Daiichi-Sankyo, Taiho, and Blue Earth, outside the submitted work. DPP reports stock or ownership from Bellicum Pharmaceuticals and TYME; grants and personal fees from Seagen, AstraZeneca, Astellas, Pfizer, Mirati, Bristol Myers Squibb, Bayer, Lilly, Roche, Clovis Oncology, and Ada Cap (Advanced Accelerator Applications); personal fees from Exelixis and Johnson & Johnson/Janssen; grants from Endocyte, Agensys, Medivation, BioXcel Therapeutics, Genentech, Innocrin Pharma, MedImmune, Merck, Millennium, Novartis, Progenics, Sanofi, Eisai, Replimune, Amgen, Bicycle Therapeutics, Boehringer Ingelheim, Incyte, Monopteros, Pharmacyclics, and Urogen; and expert testimony for Celgene and Sanofi, outside the submitted work. PHO'D reports grants and personal fees from Astellas and Seagen during the study; grants and personal fees from Genentech/Roche, Merck, Janssen, and AstraZeneca/MedImmune; personal fees from Pfizer; grants from Boehringer Ingelheim, Acerta Pharma, and Bristol-Myers Squibb; and data safety monitoring board membership for Nektar and Dragonfly Therapeutics, outside the submitted work. J-LL reports grants, personal fees, and advisory board membership from Pfizer Korea and Ipsen Korea; personal fees and advisory board membership from Sanofi Aventis, Bristol-Myers Squibb Korea, Merck Sharpe and Dohme Korea, and Astellas Korea; personal fees from Novartis Korea; and stock ownership in Myovant Science, outside the submitted work. MSvdH reports clinical trial fees from Seagen during the study; grants and personal fees from Bristol-Myers Squibb, Roche, and AstraZeneca; and personal fees from Merck Sharpe and Dohme and Seagen, outside the submitted work. YL reports personal fees from Seagen during the study; grants, personal fees, and non-financial support from Janssen and Sanofi; personal fees from Astellas, Pfizer, Bristol-Myers Squibb, and Immunomedics; grants and personal fees from Merck Sharpe and Dohme; and personal fees and non-financial support from Roche and AstraZeneca, outside the submitted work. MNS reports grants from Seagen during the study; grants from Janssen Oncology, Advaxis, Harpoon, Bristol-Myers Squibb, Genocea Biosciences, Lilly, Nektar, Exelixis, and Tmunity Therapeutics; grants and personal fees from Xencor; and personal fees from Merck Sharp and Dohme, outside the submitted work. AN reports personal fees from Seagen during the study; personal fees from Roche, Rainier Therapeutics, and Bayer; grants and personal fees from Merck, Astra Zeneca, Bristol-Myers Squibb, Janssen, and Incyte; and grants from Ipsen and Foundation Medicine, outside the submitted work. TK reports personal fees from ONO Pharmaceutical and Bristol-Myers Squibb, outside the submitted work. MRH reports grants from Seagen during the study; grants from Acerta, Merck, Clovis Oncology, and Astellas; grants and personal fees from AstraZeneca, Bayer, Pfizer, Bristol Myers Squibb, and Exelixis; and personal fees from Fujifilm, Genentech, and Janssen, outside the submitted work. DIQ reports personal fees and advisory board membership from Astellas, Seagen, Pfizer, EMD Serono, Merck, Bristol-Myers Squibb, Bayer, Genetech, AstraZeneca, and Janssen, and data safety monitoring board participation from Eisai, outside the submitted work. EIH reports investigator status for Astellas, and honoraria, travel, research funding, and participation on the advisory board for Seagen, outside the submitted work. JER reports personal fees, non-financial support, trial funding, consulting services, and writing assistance from Seagen and Astellas during the study; personal fees, trial funding, and consulting services from AstraZeneca; personal fees and honorarium from Chugai Pharma; personal fees from Eli Lilly, Bristol-Myers Squibb, EMD Serono/Pfizer, BioClin, Adicet Bio, Fortress Biotech, Western Oncolytics, GlaxoSmithKline, Janssen Oncology, Boehringer Ingelheim, Mirati, and Merck; personal fees, consulting services, and trial funding from Roche/Genentech, QED Therapeutics, and Bayer; and clinical trial funding from Novartis, outside the submitted work. S-YL, JT, and MC report employment at Seagen. BM reports personal fees from Seagen, Pfizer, Bristol-Myers Squibb, Eisai, Dendreon, and EMD Serono, and personal fees and non-financial support from Exelixis and Calithera, outside the submitted work. AVB reports contracted research fees from Seagen during the study; personal fees and contracted research and consulting fees from Seagen, Astellas, Merck, Genentech, Pfizer, Incyte, AstraZeneca, and Immunomedics; and personal fees and consulting fees for Janssen, outside the submitted work. SHP and JS declare no competing interests. Publisher Copyright: © 2021 Elsevier Ltd
PY - 2021/6/1
Y1 - 2021/6/1
N2 - Background: Locally advanced or metastatic urothelial carcinoma is generally incurable and has scarce treatment options, especially for cisplatin-ineligible patients previously treated with PD-1 or PD-L1 therapy. Enfortumab vedotin is an antibody–drug conjugate directed at Nectin-4, a protein highly expressed in urothelial carcinoma. We aimed to evaluate the efficacy and safety of enfortumab vedotin in the post-immunotherapy setting in cisplatin-ineligible patients. Methods: EV-201 is a multicentre, single-arm, phase 2 study of enfortumab vedotin in patients with locally advanced or metastatic urothelial carcinoma previously treated with PD-1 or PD-L1 inhibitors. Cohort 2 included adults (aged ≥18 years) with an Eastern Cooperative Oncology Group performance status score of 2 or less who were considered ineligible for cisplatin at enrolment and who had not received platinum-containing chemotherapy in the locally advanced or metastatic setting. Enfortumab vedotin was given intravenously at a dose of 1·25 mg/kg on days 1, 8, and 15 of every 28-day cycle. The primary endpoint was confirmed objective response rate per Response Evaluation Criteria in Solid Tumours version 1.1 assessed by blinded independent central review. Efficacy and safety were analysed in all patients who received at least one dose of enfortumab vedotin. EV-201 is an ongoing study and the primary analysis is complete. This study is registered with Clinicaltrials.gov, NCT03219333. Findings: Between Oct 8, 2017, and Feb 11, 2020, 91 patients were enrolled at 40 sites globally, of whom 89 received treatment. Median follow-up was 13·4 months (IQR 11·3–18·9). At data cutoff (Sept 8, 2020), the confirmed objective response rate was 52% (46 of 89 patients; 95% CI 41–62), with 18 (20%) of 89 patients achieving a complete response and 28 (31%) achieving a partial response. 49 (55%) of 89 patients had grade 3 or worse treatment-related adverse events. The most common grade 3 or 4 treatment-related adverse events were neutropenia (eight [9%] patients), maculopapular rash (seven [8%] patients), and fatigue (six [7%] patients). Treatment-related serious adverse events occurred in 15 (17%) patients. Three (3%) patients died due to acute kidney injury, metabolic acidosis, and multiple organ dysfunction syndrome (one [1%] each) within 30 days of first dose and these deaths were considered by the investigator to be related to treatment; a fourth death from pneumonitis occurred more than 30 days after the last dose and was also considered to be related to treatment. Interpretation: Treatment with enfortumab vedotin was tolerable and confirmed responses were seen in 52% of cisplatin-ineligible patients with locally advanced or metastatic urothelial carcinoma who were previously treated with PD-1 or PD-L1 inhibitors. These patients have few treatment options, and enfortumab vedotin could be a promising new therapy for a patient population with a high unmet need. Funding: Astellas Pharma Global Development and Seagen.
AB - Background: Locally advanced or metastatic urothelial carcinoma is generally incurable and has scarce treatment options, especially for cisplatin-ineligible patients previously treated with PD-1 or PD-L1 therapy. Enfortumab vedotin is an antibody–drug conjugate directed at Nectin-4, a protein highly expressed in urothelial carcinoma. We aimed to evaluate the efficacy and safety of enfortumab vedotin in the post-immunotherapy setting in cisplatin-ineligible patients. Methods: EV-201 is a multicentre, single-arm, phase 2 study of enfortumab vedotin in patients with locally advanced or metastatic urothelial carcinoma previously treated with PD-1 or PD-L1 inhibitors. Cohort 2 included adults (aged ≥18 years) with an Eastern Cooperative Oncology Group performance status score of 2 or less who were considered ineligible for cisplatin at enrolment and who had not received platinum-containing chemotherapy in the locally advanced or metastatic setting. Enfortumab vedotin was given intravenously at a dose of 1·25 mg/kg on days 1, 8, and 15 of every 28-day cycle. The primary endpoint was confirmed objective response rate per Response Evaluation Criteria in Solid Tumours version 1.1 assessed by blinded independent central review. Efficacy and safety were analysed in all patients who received at least one dose of enfortumab vedotin. EV-201 is an ongoing study and the primary analysis is complete. This study is registered with Clinicaltrials.gov, NCT03219333. Findings: Between Oct 8, 2017, and Feb 11, 2020, 91 patients were enrolled at 40 sites globally, of whom 89 received treatment. Median follow-up was 13·4 months (IQR 11·3–18·9). At data cutoff (Sept 8, 2020), the confirmed objective response rate was 52% (46 of 89 patients; 95% CI 41–62), with 18 (20%) of 89 patients achieving a complete response and 28 (31%) achieving a partial response. 49 (55%) of 89 patients had grade 3 or worse treatment-related adverse events. The most common grade 3 or 4 treatment-related adverse events were neutropenia (eight [9%] patients), maculopapular rash (seven [8%] patients), and fatigue (six [7%] patients). Treatment-related serious adverse events occurred in 15 (17%) patients. Three (3%) patients died due to acute kidney injury, metabolic acidosis, and multiple organ dysfunction syndrome (one [1%] each) within 30 days of first dose and these deaths were considered by the investigator to be related to treatment; a fourth death from pneumonitis occurred more than 30 days after the last dose and was also considered to be related to treatment. Interpretation: Treatment with enfortumab vedotin was tolerable and confirmed responses were seen in 52% of cisplatin-ineligible patients with locally advanced or metastatic urothelial carcinoma who were previously treated with PD-1 or PD-L1 inhibitors. These patients have few treatment options, and enfortumab vedotin could be a promising new therapy for a patient population with a high unmet need. Funding: Astellas Pharma Global Development and Seagen.
UR - http://www.scopus.com/inward/record.url?scp=85106344133&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/S1470-2045(21)00094-2
DO - https://doi.org/10.1016/S1470-2045(21)00094-2
M3 - Article
C2 - 33991512
SN - 1470-2045
VL - 22
SP - 872
EP - 882
JO - lancet oncology
JF - lancet oncology
IS - 6
ER -