TOPACIO/Keynote-162: Niraparib + pembrolizumab in patients (pts) with metastatic triple-negative breast cancer (TNBC), a phase 2 trial.
Abstract
1011 Background: Chemotherapy is a standard of care for TNBC despite its suboptimal efficacy. ≈15–20% of TNBC have BRCA1/2 mutations (mut); ≈75% of BRCA1 mut BCs are TN. Single agent poly(ADP-ribose) polymerase (PARP) inhibitors have clinical activity in pts with BRCA1/2 mutations (BRCAmut) BC and provide median PFS of 6 mos in pts with BRCAmut TNBC vs 3.5 mos for chemotherapy. Single-agent pembrolizumab (pembro), a programmed death 1(PD–1) inhibitor, has shown objective response rates (ORR) of 5–18% in previously treated TNBC. TOPACIO (NCT02657889) is a fully enrolled study evaluating the safety and efficacy of combination treatment with selective PARP1/2 inhibitor niraparib + pembro in pts with met TNBC. Methods: Pts received niraparib 200 mg orally once daily + pembro 200 mg IV on day 1 of each 21-day cycle. Primary efficacy endpoint was ORR and secondary endpoints included disease control rate (DCR = CR+PR+SD [stable disease]). Results: As of Jan 2018, 12 of 54 enrolled TNBC pts (22%) had deleterious BRCAmut; 9 (17%) not tested/indeterminate results. Median age was 54 yrs, with median of 1 prior line of therapy in the met setting (range 0–3); 22 (41%) had received prior platinum in the met setting; 39 (72%) had received prior (neo)adjuvant therapy. Forty-five pts were evaluable, with ≥1 on-study scan. To date, ORR is 29% and DCR is 49%, including 3 CR (7%), 10 PR (22%), 9 SD (20%), and 23 progressive disease (PD) (51%). Ten of 13 responders have ongoing responses; 13 pts have received > 6 mos of treatment (6 BRCAmut, 5 BRCAwt, 2 BRCAunk); 11 pts remain on treatment. The 12 BRCAmut pts were 1 CR, 7 PR, 1 SD and 3 PD. Median PFS in BRCAmut group is 8.1 mos (95% CI 0.2–NE). ORR (any BRCA status) was 33% in PD-L1-pos (combined proportion score ≥1%) vs 15% in PD-L1-neg pts. Treatment-related grade ≥3 AEs occurred in 27 pts (50%); most common were thrombocytopenia (13%) & anemia (11%). Follow-up is ongoing. Conclusions: Preliminary activity is encouraging with durable responses observed irrespective of BRCA1/2 or PD-L1 status or prior platinum exposure with the highest ORR in BRCAmut pts. No new safety signals were identified with the combination. Clinical trial information: NCT02657889. ORR DCR TNBC overall, n = 45 29% 49% TNBC BRCAmut, n = 12 67% 75%
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Accumulating evidence indicates that PARPi plus α-PD-1/PD-L1 is a promising combination strategy in multiple types of cancers, including metastatic castrate-resistant prostate cancer and metastatic TNBC.
“Accumulating evidence indicates that PARPi plus α-PD-1/PD-L1 is a promising combination strategy in multiple types of cancers, including metastatic castrate-resistant prostate cancer and metastatic TNBC [230, 231].”
From Combination strategies with PD-1/PD-L1 blockade: current advances and future directions (2022) · cites this paper as [231]
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“16, 17 Specific to metastatic TNBC, the results of the TOPACIO study illustrated a 28% objective response rate and progression-free survival of 8.3 months for those whose tumors harbored a BRCA mutation.”
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“This agrees with results seen evaluating this combination in other malignancies, including preliminary results from the TOPACIO/Keynote-162 trial in breast and ovarian cancer (NCT02657889), in which PARPi in combination with checkpoint blockade led to durable clinical responses (including higher response rates in pati…”
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“Till now, only three PARP inhibitor/anti-PD-1/ L1 combos have been studied: olaparib/durvalumab([26,27]), niraparib/pbrobrolizumab([28,29]), and BGB-A 317/BGB-290([30]).”
BackgroundStandard changing news der Senologie und der Gynäkologischen Onkologie 2018
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“Aktuell läuft zudem ein Studienkonzept, welches den Einsatz von selektiven PARP-Inhibitoren beim HER2-negativen Mammakarzinom mit homologer rekombinanter Defizienz (HRD) [BRCA1/2-Mutation oder hoher HRD-Score] im Vergleich zur platinhaltigen Chemotherapie und anschließender Behandlung mit Epirubicin und Cyclophosphami…”
BackgroundInfluentialDie systemische Behandlung des triple-negativen Mammakarzinoms
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“Specifically, majority of the clinical trials have examined that such combined strategies have tolerance for patients and are effective in several tumor types, including breast cancers [41 – 44], ovarian cancers [45,46], and prostate cancers [47].”
Background
- Authors
- Vinayak, S., Tolaney, S. M., Schwartzberg, L. S., Mita, M. M., McCann, G. A.-L., Tan, A. R., Wahner Hendrickson, A. E., Forero-Torres, A., Anders, C. K., Wulf, G. M., Dillon, P. M., Lynce, F., Zarwan, C., Erban, J. K., Dezube, B. J., Zhou, Y., Buerstatte, N., Arora, S., Achour, H., & Telli, M. L.
- Affiliations
- Case Comprehensive Cancer Center (US)
- Dana-Farber Cancer Institute (US)
- The West Clinic, Memphis, TN;
- Cedars-Sinai Medical Center (US)
- The University of Texas at San Antonio Health Science Center (US)
- Levine Cancer Institute (US)
- Mayo Clinic Rochester, Rochester, MN;
- University of Alabama at Birmingham, Birmingham, AL;
- University of North Carolina at Chapel Hill (US)
- Beth Israel Deaconess Medical Center (US)
- University of Virginia (US)
- MedStar Georgetown University Hospital (US)
- Lahey Hospital and Medical Center (US)
- Tufts Medical Center (US)
- Tesaro (United States) (US)
- Stanford University (US)
- ORCID
- Venue
- Journal of Clinical Oncology
- Published
- 2018-05-20
- Volume
- 36
- Issue
- 15_suppl
- Pages
- 1011-1011
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W2807543909
- Cited by
- 77
- References
- 0
- Citations by year
- 2025: 1 · 2024: 7 · 2023: 2 · 2022: 11 · 2021: 14 · 2020: 14 · 2019: 23 · 2018: 5
- Type
- conference abstract
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Oncology (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › PARP inhibition in cancer therapy
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Breast Cancer Treatment Studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Advanced Breast Cancer Therapies
- Keywords
- niraparib, pembrolizumab, metastatic triple-negative breast cancer, PARP inhibitors, PD-1 inhibitors, BRCA mutations, combination immunotherapy, objective response rate, disease control rate, platinum-refractory disease, safety and tolerability, immune-related adverse events, PD-L1
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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