Combination therapy with the PD-L1 inhibitor atezolizumab (Tecentriq) and the MEK inhibitor cobimetinib (Cotellic) failed to improve overall survival (OS) versus regorafenib (Stivarga) in previous treated patients with locally advanced or metastatic colorectal cancer (CRC), according to topline findings from the phase III IMblaze370 study.
wild-type, and the status of 2 patients was unknown. Sixty-six (79%) had received ≥5 previous systemic therapies.
At baseline, 42 patients (50%) were MSS, 9 (11%) were microsatellite instability (MSI)-low, and 1 (1%) was MSI-high. MSI status was unknown for 32 patients (38%). The median patient age was 56.5 years (range, 23-81) and 44% of patients were female. For PD-L1 expression, 57% were immune cell (IC) 0/1 and 8% were IC2/3. PD-L1 expression was unknown for 29 patients (35%).
Stage 1 established 60 mg of cobimetinib as the treatment dose for patients with chemotherapy-refractory or locally advanced mCRC in stage 2. In stage 2, patients were assigned to a cobimetinib regimen of 21 days on/7 days off (n = 59) or 14 days on/14 days off (n = 21). Patients in both groups received 800 mg of atezolizumab every 2 weeks.
At the September 4, 2017, data cutoff, ORR was 8% (95% CI, 1-26) in KRAS
wild-type patients, with a DCR of 32%. In KRAS
-positive patients, ORR was 9% (95 CI, 3-19) with a DCR of 30%.
The median duration of response was 14.3 months (95% CI, 6.0-not evaluable). Among the 7 patients who responded to treatment, 4 had MSS and 1 had MSI-low disease. MSI status was unknown in the remaining 2 patients.
The median overall PFS was 1.9 months (95% CI, 1.8-2.3). The median PFS was 2.5 months (95% CI, 1.8-3.7) in MSS patients, 2.0 months (95% CI, 1.8-2.3) in KRAS
-mutant patients, and 1.8 months (95% CI, 1.8-2.6) in KRAS
wild-type patients. The 6-month PFS rate was 18% overall, 27% in MSS patients, 22% in KRAS
-mutant patients, and 9% in KRAS wild-type patients.
The median OS was 9.8 months (95% CI, 6.2-14.1), with a 6-month OS rate of 65% and a 12-month OS rate of 43%. For MSS patients, the median OS was 13.0 months (95% CI, 6.0-25.8), with a 6-month OS rate of 71% and a 12-month OS rate of 51%.
The median OS was 9.5 months (95% CI, 6.0-17.6) in KRAS
mutant patients, with a 6-month OS rate of 67%. The median OS was 10.0 months (95% CI, 4.9-17.1) in KRAS
wild-type patients, with a 6-month OS rate of 65% and a 12-month OS rate of 43%.
Investigators concluded that the combination was generally well tolerated and the majority of adverse events (AEs) were manageable. Overall, 98% of the cohort experienced any-grade, any-cause AEs, and 96% experienced treatment-related (TR) AEs. There were no grade 5 AEs recorded, but 32 patients (38%) experienced grade 3/4 AEs.
Rash, diarrhea, fatigue, and increased blood creatine phosphokinase were the most common grade 3/4 TRAEs (5% each). Thirty-eight patients (45%) experienced serious AEs, and 10 (12%) had serious TRAEs. Twenty patients (24%) withdrew due to AEs. Eleven (13%) withdrew due to AEs associated with atezolizumab and 20 (24%) due to AEs associated with cobimetinib.
Bendell JC, Bang YJ, Chee CE, et al. A phase Ib study of safety and clinical activity of atezolizumab (A) and cobimetinib (C) in patients (pts) with metastatic colorectal cancer (mCRC). J Clin Oncol. 2018;36, (suppl 4S; abstr 560).