Britta Kaltoft, Herlev HospitalPhilip Blach Rossen, Århus Sygehus

Hotel Hilton, 17. juni

• Gastrointestinal Stromal Tumor (GIST)

• Soft Tissue Sarcoma (STS)

• Osteosarcoma (OS)

• 64 posters, 29 poster discussions, 9 oral presentations, 1 plenary session

Study hypothesis:

Three years of adjuvant imatinib may result in longer Recurrence Free Survival (RFS) aslonger Recurrence Free Survival (RFS) as compared to one year of imatinib

The ATP binding pocket of the KIT kinase domain

Kinase

of the KIT kinase domain is occupied by imatinib1

Signaling is inhibited by domainsprevention of substrate

phosphorylation1

With signaling inhibited,P

PP PATP

With signaling inhibited, proliferation and survival are interrupted1,2

PP P

SIGNALING

Imatinibmesylate

SIGNALING

1. Savage DG et al. N Engl J Med. 2002;346:683-693.

2. Scheijen B et al. Oncogene. 2002;21:3314-3333.

80–85% 5–7%KIT PDGFR-αOverall mutation frequency: 87.4%

← MembraneExon 9 (11%)

Exon 11 (67.5%)Exon 13 (0.9%)

Exon 12 (0.9%)Exon 14 (0.3%)

Cytoplasm

Exon 17 (0.5%) Exon 18 (6.3%)

Gain of function mutations result in abnormal constitutively activatedGain-of-function mutations result in abnormal, constitutively activated receptor tyrosine kinase activityLigand-independent mitogenic activityStimulation of downstream signaling pathwaysStimulation of downstream signaling pathways

1. Heinrich et al. Hum Pathol. 2002;33:484.2. Corless et al. Proc Am Assoc Cancer Res. 2003;44. Abstract R4447.

Objectives:

• Primary: RFSTime from randomization to GIST recurrenceTime from randomization to GIST recurrence or death

• Secondary:Safety and overall survival

Inclusion criteria:• Histologically confirmed

GIST d KIT iti

Exclusion criteria:• Inoperable, recurrent or

t t ti GIST *GIST and KIT-positive• High risk recurrence risk

(consensus criteria):

metastatic GIST *• Age < 18

ECOG PS 2(consensus criteria):- Diameter > 10 cm or

Tumor mitosis count >

• ECOG PS > 2• > 12 weeks between

date of surgery and- Tumor mitosis count > 10/50 HPF or- Tumor rupture

date of surgery and study entry

• Clinically significant- Tumor rupture • Clinically significant cardiac, hepatic, renal and bone marrow disease

Conclusion:

• One vs three years of imatinib improves RFSOne vs three years of imatinib improves RFS and OS

• Relatively well tolerated

• How would RFS and OS have been without the R1-group (tumor rupture)?

• Which patients? How long?

• Inhibits KIT, PDGFR, FGFR, VEGFR 2,3, TIE-2 and B-RAF

• Approximately 24 hours half-lives

• Primary objective:Clinical Benefit Rate (CR, PR or durable SD)

• Secondary objective:ORR, PFR, OS, Safety

• 160 mg once daily day 1-21 of a 28-days cycle

• Adverse Events (all grades):Fatigue, Hand Foot Skin Reaction and gHypertension

• Adverse Events (grade 3-4):Hypertension Hand Foot Skin Reaction andHypertension, Hand Foot Skin Reaction and Hypophosphatemia

Conclusion:

Activity of regorafenib in patients with advanced GIST following failure of both IM and SUGIST following failure of both IM and SU

• A multikinase angionesis inhibitor targeting VEGFR, PDGFR and c-KIT

• Prior phase II study was promissing withPrior phase II study was promissing with acceptable toxicity profile, although insufficient activity in adipocytic sarcomasactivity in adipocytic sarcomas

Multicenter study: 4 continents, 13 countries, 72 institutions19 patients still on protocol therapy

Inclusion criteriaAge > 18 WHO PS 0 1 Including histology criteria• Age > 18, WHO PS 0-1

• PD during the last sixmonths (or 12 months in

Including histology criteria• Fibroblastic• Fibrohistocyticmonths (or 12 months in

case of (neo)-adjuvanttreatment only)

y• Leiomyosarcoma• Synovial sarcoma

• Up to four lines of prior treatment (includinganthracycline)

• MPNST• NOSanthracycline)

• RECIST 1.0 measurable• Angiogenesis inhibitor-

• Vascular STS• Malignant glomus tumorsg g

naive• Adequate major organ

f ifunction• No poorly controlled

hypertension bleedinghypertension, bleedingdiathesis or CNS involvement

Grade 3 in pazopanib-group: • Fatigue (13 %)• Hypertension (16%)• Anorexia (14%)• Diarrhea (11%)• Affected liver chemistry (4-30%)

Other:• Myocardial dysfunction (5 vs 10%)• Venous tromboembolic (5 vs 18%)• Pneumothorax (0 vs 8%)

Conclusion:

Pazopanib is an active drug in pretreated metastatic STS patients improving PFS 3-foldmetastatic STS patients improving PFS 3-fold

Adverse Events are manageable

Final OS analysis is anticipated in 2011

• Focus on PFS > OS

• Imatinib as adjuvant treatment; which patients? And how long?patients? And how long?

Further knowledge on subgroups; which• Further knowledge on subgroups; which patients should have treatment?

• Pazopanib, regorafenib; other ib’s, ab’s and mus’s

Questions