Reference Detail

Ref Type

Journal Article

PMID

(38653864)

Authors

Friedman CF, Manning-Geist BL, Zhou Q, Soumerai T, Holland A, Da Cruz Paula A, Green H, Ozsoy MA, Iasonos A, Hollmann T, Leitao MM, Mueller JJ, Makker V, Tew WP, O'Cearbhaill RE, Liu YL, Rubinstein MM, Troso-Sandoval T, Lichtman SM, Schram A, Kyi C, Grisham RN, Causa Andrieu P, Wherry EJ, Aghajanian C, Weigelt B, Hensley ML, Zamarin D

Title

Nivolumab for mismatch-repair-deficient or hypermutated gynecologic cancers: a phase 2 trial with biomarker analyses.

Journal	Vol	Issue	Date	Pages	Journal Short Title
Nature medicine	30	5	2024 May	1330-1338	Nat Med

URL

Abstract Text

Programmed death-1 (PD-1) inhibitors are approved for therapy of gynecologic cancers with DNA mismatch repair deficiency (dMMR), although predictors of response remain elusive. We conducted a single-arm phase 2 study of nivolumab in 35 patients with dMMR uterine or ovarian cancers. Co-primary endpoints included objective response rate (ORR) and progression-free survival at 24 weeks (PFS24). Secondary endpoints included overall survival (OS), disease control rate (DCR), duration of response (DOR) and safety. Exploratory endpoints included biomarkers and molecular correlates of response. The ORR was 58.8% (97.5% confidence interval (CI): 40.7-100%), and the PFS24 rate was 64.7% (97.5% one-sided CI: 46.5-100%), meeting the pre-specified endpoints. The DCR was 73.5% (95% CI: 55.6-87.1%). At the median follow-up of 42.1 months (range, 8.9-59.8 months), median OS was not reached. One-year OS rate was 79% (95% CI: 60.9-89.4%). Thirty-two patients (91%) had a treatment-related adverse event (TRAE), including arthralgia (n = 10, 29%), fatigue (n = 10, 29%), pain (n = 10, 29%) and pruritis (n = 10, 29%); most were grade 1 or grade 2. Ten patients (29%) reported a grade 3 or grade 4 TRAE; no grade 5 events occurred. Exploratory analyses show that the presence of dysfunctional (CD8+PD-1+) or terminally dysfunctional (CD8+PD-1+TOX+) T cells and their interaction with programmed death ligand-1 (PD-L1)+ cells were independently associated with PFS24. PFS24 was associated with presence of MEGF8 or SETD1B somatic mutations. This trial met its co-primary endpoints (ORR and PFS24) early, and our findings highlight several genetic and tumor microenvironment parameters associated with response to PD-1 blockade in dMMR cancers, generating rationale for their validation in larger cohorts.ClinicalTrials.gov identifier: NCT03241745 .

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Molecular Profile	Treatment Approach

Gene Name	Source	Synonyms	Protein Domains	Gene Description	Gene Role

Therapy Name	Drugs	Efficacy Evidence	Clinical Trials

Drug Name	Trade Name	Synonyms	Drug Classes	Drug Description

Gene	Variant	Impact	Protein Effect	Variant Description	Associated with drug Resistance

Molecular Profile	Indication/Tumor Type	Response Type	Therapy Name	Approval Status	Evidence Type	Efficacy Evidence	References
MLH1 negative	ovarian carcinoma	predicted - sensitive	Nivolumab	Phase II	Actionable	In a Phase II trial, Opdivo (nivolumab) treatment resulted in an objective response rate of 58.8% (20/34, 7 complete and 13 partial responses) and a progression-free survival rate at 24 mo of 64.7% in patients with MSI-high or deficient mismatch repair (dMMR defined by the loss of MLH1, PMS2, MSH2, or MSH6 expression by IHC) ovarian or endometrial carcinoma, including responses in 2 patients with uterine clear cell carcinoma and 1 patient with ovarian clear cell carcinoma (PMID: 38653864; NCT03241745).	38653864
MSH6 negative	endometrial carcinoma	sensitive	Nivolumab	Phase II	Actionable	In a Phase II trial, Opdivo (nivolumab) treatment resulted in an objective response rate of 58.8% (20/34, 7 complete and 13 partial responses) and a progression-free survival rate at 24 mo of 64.7% in patients with MSI-high or deficient mismatch repair (dMMR defined by the loss of MLH1, PMS2, MSH2, or MSH6 expression by IHC) ovarian or endometrial carcinoma, including responses in 2 patients with uterine clear cell carcinoma and 1 patient with ovarian clear cell carcinoma (PMID: 38653864; NCT03241745).	38653864
MSH6 negative	ovarian carcinoma	predicted - sensitive	Nivolumab	Phase II	Actionable	In a Phase II trial, Opdivo (nivolumab) treatment resulted in an objective response rate of 58.8% (20/34, 7 complete and 13 partial responses) and a progression-free survival rate at 24 mo of 64.7% in patients with MSI-high or deficient mismatch repair (dMMR defined by the loss of MLH1, PMS2, MSH2, or MSH6 expression by IHC) ovarian or endometrial carcinoma, including responses in 2 patients with uterine clear cell carcinoma and 1 patient with ovarian clear cell carcinoma (PMID: 38653864; NCT03241745).	38653864
MLH1 negative	endometrial carcinoma	sensitive	Nivolumab	Phase II	Actionable	In a Phase II trial, Opdivo (nivolumab) treatment resulted in an objective response rate of 58.8% (20/34, 7 complete and 13 partial responses) and a progression-free survival rate at 24 mo of 64.7% in patients with MSI-high or deficient mismatch repair (dMMR defined by the loss of MLH1, PMS2, MSH2, or MSH6 expression by IHC) ovarian or endometrial carcinoma, including responses in 2 patients with uterine clear cell carcinoma and 1 patient with ovarian clear cell carcinoma (PMID: 38653864; NCT03241745).	38653864