On January 16, 2015 OncoMed Pharmaceuticals reported final safety, efficacy and biomarker data from the company’s Phase 1b "ALPINE" clinical trial of tarextumab (anti-Notch2/3, OMP-59R5) in 40 patients with frontline metastatic pancreatic cancer (Press release OncoMed, JAN 16, 2015, View Source [SID:1234501384]).
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Tarextumab was generally well tolerated when administered with gemcitabine and Abraxane (paclitaxel protein-bound particles for injectable suspension) (albumin bound), with manageable, on-target drug-related toxicities. The Phase 2 dose of tarextumab was determined to be 15 mg/kg every two weeks in combination with the standard-of-care. Among patients evaluable for response using RECIST criteria, 38 percent (11 of 29) achieved partial responses, with an additional 35 percent achieving stable disease (10 of 29) for an overall clinical benefit rate of 73 percent (21 of 29 patients). Median progression-free survival and overall survival values for the three drug combination of tarextumab-gemcitabine-Abraxane were 5.6 months and 11.6 months, respectively, for all patients treated with the three-drug combination.
The data presented included biomarker analyses that showed that among patients whose tumor samples had elevated levels of Notch3 gene expression, trends toward higher response rates and longer survival were noted, as compared to patients with low Notch3 expression. Median PFS and OS for patients with high Notch 3 expression (using a 50% cut-off) were 6.6 months and 14.6 months, respectively. Given the small sample size and potential imbalances in patient characteristics, these encouraging preliminary efficacy and predictive biomarker observations are being assessed in the ongoing randomized, placebo-controlled, Phase 2 ALPINE trial
"The positive data from the Phase 1b study of tarextumab in first line pancreatic cancer patients provide us with clear support for the advancement of this drug into Phase 2," said Paul J. Hastings, OncoMed’s Chairman and Chief Executive Officer. "The randomized Phase 2 ALPINE study, which began enrolling patients in July of 2014, is enrolling rapidly and we believe the ALPINE study will be the first of our randomized Phase 2 trials to read out, with data expected in the first half 2016."
"Tumor Notch3 gene expression is estimated to be elevated in approximately 70 percent of pancreatic cancer patients and it is thought to be an indicator of poor prognosis and chemotherapy resistance. The data suggesting that the biomarker-positive patients may have improved response rates and survival with tarextumab treatment are supportive of the Phase 2 design of the ALPINE study where tarextumab’s impact on efficacy of all patients enrolled as well as the biomarker positive patients will be assessed. The Notch3 predictive biomarker may enable us to identify those patients that would gain the greatest benefit from tarextumab treatment," added Jakob Dupont, M.D., OncoMed’s Chief Medical Officer.
"Pancreatic cancer remains among the most challenging cancers in spite of recent treatment advances. The Phase 1b tarextumab data confirm safety and early signals of efficacy observed in earlier stage studies," said Eileen O’Reilly, M.D., Associate Director, Clinical Research with Memorial Sloan Kettering Cancer Center and a Principal Investigator of ALPINE. "Further exploration of tarextumab’s potential as a new treatment option for pancreatic cancer patients is warranted and ongoing in the randomized Phase 2 portion of the study. The trial will evaluate the addition of tarextumab in a frontline untreated pancreas cancer population and in specific biomarker-selected subsets."
In the Phase 1b study, tarextumab was administered to standard-of-care chemotherapy to 40 patients with previously untreated, metastatic pancreatic cancer. Thirty-one of the patients received the combination of gemcitabine, Abraxane and tarextumab. Escalating doses of tarextumab were administered every two weeks, ranging from 2.5 mg/kg to 15 mg/kg. Diarrhea, fatigue and anemia were the most common treatment-related toxicities, and the events were mostly Grade 1 or 2, and managed with supportive care. The randomized, double blinded Phase 2 portion of the ALPINE study is currently enrolling patients with first-line advanced pancreatic cancer at 36 clinical sites in the United States. Data are anticipated in the first half of 2016 for both the intent to treat population as well as the tumor Notch3 biomarker positive patients.