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PURPOSE The phase II single-arm KEYNOTE-052 study evaluated the efficacy and safety of first-line pembrolizumab for patients with locally advanced or metastatic cisplatin-ineligible urothelial carcinoma (UC). PATIENTS AND METHODS Three hundred seventy patients received pembrolizumab 200 mg intravenously every 3 weeks for up to 24 months. Positive tumor programmed death ligand 1 (PD-L1) expression was defined as combined positive score (CPS) ≥ 10. Response was assessed by independent central review every 9 weeks per RECIST v1.1. The primary end point was objective response rate (ORR). RESULTS At data cutoff (September 26, 2018), the minimum follow-up was 2 years since the last patient enrolled. ORR was 28.6% (95% CI, 24.1% to 33.5%); 33 patients (8.9%) and 73 patients (19.7%) achieved complete and partial response, respectively. The median duration of response was 30.1 months (95% CI, 18.1 months to not reached [NR]); responses lasted ≥ 12 and ≥ 24 months in 67% and 52% of patients, respectively. Forty patients with complete or partial response completed 2 years of study treatment, and 32 had ongoing response at completion. Median overall survival (OS) was 11.3 months (95% CI, 9.7 to 13.1 months), and 12- and 24-month OS rates were 46.9% and 31.2%, respectively. In patients with CPS ≥ 10, ORR was 47.3% (95% CI, 37.7% to 57.0%) and median OS was 18.5 months (95% CI, 12.2 to 28.5 months). In patients with lymph node–only disease, ORR was 49.0% (95% CI, 34.8% to 63.4%), and median OS was 27.0 months (12.4 months to NR). There were no new safety signals. CONCLUSION First-line pembrolizumab confers meaningful and durable clinical response in cisplatin-ineligible patients with advanced UC and is associated with prolonged OS, particularly with PD-L1 CPS ≥ 10 and lymph node–only disease.

Oncogenic RET fusions occur in diverse cancers. Pralsetinib is a potent, selective inhibitor of RET receptor tyrosine kinase. ARROW (NCT03037385, ongoing) was designed to evaluate pralsetinib efficacy and safety in patients with advanced RET-altered solid tumors. Twenty-nine patients with 12 different RET fusion–positive solid tumor types, excluding non-small-cell lung cancer and thyroid cancer, who had previously received or were not candidates for standard therapies, were enrolled. The most common RET fusion partners in 23 efficacy-evaluable patients were CCDC6 (26%), KIF5B (26%) and NCOA4 (13%). Overall response rate, the primary endpoint, was 57% (95% confidence interval, 35–77) among these patients. Responses were observed regardless of tumor type or RET fusion partner. Median duration of response, progression-free survival and overall survival were 12 months, 7 months and 14 months, respectively. The most common grade ≥3 treatment-related adverse events were neutropenia (31%) and anemia (14%). These data validate RET as a tissue-agnostic target with sensitivity to RET inhibition, indicating pralsetinib’s potential as a well-tolerated treatment option with rapid, robust and durable anti-tumor activity in patients with diverse RET fusion–positive solid tumors.

17 Background: ARV-110 is a first-in-class, oral PROteolysis TArgeting Chimera (PROTAC) protein degrader that selectively targets AR. Patients (pts) with mCRPC have limited treatment (tx) options due to decreasing AR dependence of tumors upon successive therapies. Previous phase 1 data indicated clinical activity for ARV-110 in heavily pretreated pts with mCRPC and suggested enhanced activity in pts with specific molecular profiles, eg, AR T878 and H875 mutations, leading to a phase 2 expansion (ARDENT) to further characterize ARV-110 in biomarker-defined pt subgroups. We report results of the ongoing phase 1/2 study. Methods: In phase 1, pts with mCRPC and disease progression after ≥2 prior therapies (enzalutamide and/or abiraterone required) received ARV-110 orally once or twice daily (QD or BID) in sequential cohorts (3 + 3 dose escalation design). Primary objectives were to assess ARV-110 safety and select the recommended phase 2 dose (RP2D). Phase 2 pts with mCRPC and 1–2 prior novel hormonal agents (NHAs) ± chemotherapy were assigned to 3 biomarker-defined subgroups: 1) AR T878 and/or H875 mutations, 2) AR L702H mutation or AR-V7 (variants not degraded by ARV-110 in nonclinical studies), and 3) wild-type AR or other AR alterations. A fourth subgroup enrolled pts based on clinical history of less prior tx: ≤1 therapy for mCRPC, 1 NHA, and no chemotherapy. Primary objective is to assess ARV-110 antitumor activity. Results: As of Aug 26, 2021, 173 pts were enrolled (67 in phase 1; 106 in phase 2). In phase 1, ARV-110 doses ranged from 35–700 mg QD or 210–420 mg BID; 420 mg QD was selected as the RP2D based on safety, pharmacokinetics, and efficacy. Across 140 biomarker-evaluable phase 1/2 pts with ≥1 month of prostate-specific antigen (PSA) follow-up, 26 with AR T878A/S and/or H875Y mutations had best PSA declines ≥50% (PSA50) and ≥30% (PSA30) of 46% and 58%, respectively, vs 10% and 23% in 114 pts without these mutations. Of 7 RECIST-evaluable pts with AR T878A/S and/or H875Y mutations, 6 had tumor shrinkage (2 with confirmed partial responses), and 4 remain on tx. Five of 19 (26%) PSA-evaluable pts in the fourth subgroup (only 1 prior NHA; no prior chemotherapy) achieved PSA50. Overall PSA50 and PSA30 response rates were 16% and 29%, respectively. There were no grade ≥4 tx-related adverse events (TRAEs) in 113 pts treated at the RP2D. The most common any grade TRAEs at the RP2D were nausea (42%; grade 3: 1%), fatigue (27%; grade 3: 1%), vomiting (23%; grade 3: 1%), decreased appetite (19%; grade 3: 0), diarrhea (15%; grade 3: 2%), and alopecia (11%). Conclusions: ARV-110, a novel AR protein degrader, demonstrates clinical activity in a post-NHA, heavily pretreated mCRPC pt population, with greatest PSA50 activity and RECIST responses in pts with AR T878 and/or H875 mutations, likely representing a particularly ARV-110–sensitive population. ARV-110 merits further investigation in pts with mCRPC. Clinical trial information: NCT0388861.

Surgical resection of residual mass after chemotherapy plays an integral role in the management of patients with primary mediastinal nonseminoma. Teratoma and viable tumor were found in the majority of resected residua after chemotherapy. Because patients who undergo conventional salvage chemotherapy programs rarely achieve long-term disease-free status, selected patients with elevated markers after chemotherapy are considered candidates for surgical resection.

PEG-IFN is a modified form of IFNalpha2a with distinct pharmacokinetic advantages and immunomodulatory and antitumor activity for patients with advanced RCC. A dose of 450 microg/wk by subcutaneous administration was determined as a suitable dose for further study. PEG-IFN is more convenient to administer than IFNalpha and has potential for increased efficacy, less toxicity, or both. The efficacy and toxicity of PEG-IFN will be further assessed in clinical trials and compared with IFNalpha.

This trial does not support the routine use of thalidomide to induce partial response for metastatic RCC. Because disease stabilization occurs as a part of the natural history of metastatic RCC, the potential effect of thalidomide on progression-free and overall survival for patients with advanced RCC is being addressed in a randomized phase III trial. New immunomodulatory analogs of thalidomide that have shown potentially greater antitumor effects in preclinical models warrant study in metastatic RCC.