title: Phase II study of the antibody-drug conjugate TAK-264 (MLN0264) in patients with metastatic or recurrent adenocarcinoma of the stomach or gastroesophageal junction expressing guanylyl cyclase C.
abstract: Background The first-in-class antibody-drug conjugate TAK-264 (formerly MLN0264) consists of an antibody targeting guanylyl cyclase C (GCC) conjugated to monomethyl auristatin E (MMAE) via a peptide linker. This phase II study evaluated the efficacy and safety of TAK-264 in patients with adenocarcinoma of the stomach or gastroesophageal junction expressing GCC, who had progressed on ≥1 line of prior therapy. Methods This study used a two-stage design, with an interim analysis conducted after stage I to determine whether to continue to stage II or discontinue on the grounds of futility. Adult patients with gastric and gastroesophageal junction adenocarcinoma expressing low, intermediate, or high GCC levels received TAK-264 1.8 mg/kg as a 30-min intravenous infusion once every 21 days, for up to 1 year. The primary endpoint was objective response rate. Radiographic assessments of tumor burden were performed every 2 cycles (6 weeks). Results A total of 38 patients participated in the study. Patients received a median of 2 (range 1-14) cycles; 8 (21%) received at least 6 cycles. The most common adverse events were nausea (53%), fatigue (32%), and decreased appetite (29%). Grade ≥3 events including anemia, diarrhea, and neutropenia were seen in 14 (37%) patients. Systemic exposure to TAK-264 was maintained throughout each treatment cycle. Two patients (6%) with intermediate GCC expression had objective responses. Conclusions TAK-264 demonstrated a manageable safety profile in this patient population. The stage I interim analysis did not support continuation to stage II of the study.
authors.affiliation: Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA. Khaldoun.Almhanna@moffitt.org.
authors.forename: Khaldoun
authors.initials: K
authors.lastname: Almhanna
authors.affiliation: Hospital Universitario Virgen del Rocio, Seville, Spain.
authors.forename: Maria Luisa Limon
authors.initials: ML
authors.lastname: Miron
authors.affiliation: Florida Cancer Specialists, Tampa, FL, USA.
authors.forename: David
authors.initials: D
authors.lastname: Wright
authors.affiliation: HM Universitario Sanchinarro, CIOCC, Madrid, Spain.
authors.forename: Antonio Cubillo
authors.initials: AC
authors.lastname: Gracian
authors.affiliation: The Christie NHS Foundation Trust, Manchester, UK.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hubner
authors.affiliation: Erasme University Hospital, Brussels, Belgium.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Van Laethem
authors.affiliation: Hospital Universitario Virgen de la Victoria, Málaga, Spain.
authors.forename: Carolina Muriel
authors.initials: CM
authors.lastname: López
authors.affiliation: Vall d'Hebron University Hospital and VHIO-Vall d'Hebron Institute of Oncology, Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Alsina
authors.affiliation: Ramon y Cajal University Hospital, Madrid, Spain.
authors.forename: Frederico Longo
authors.initials: FL
authors.lastname: Muñoz
authors.affiliation: Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN, USA.
authors.forename: Johanna
authors.initials: J
authors.lastname: Bendell
authors.affiliation: The Christ Hospital Physicians, Cincinnati, OH, USA.
authors.forename: Irfan
authors.initials: I
authors.lastname: Firdaus
authors.affiliation: University of Colorado, Denver, CO, USA.
authors.forename: Wells
authors.initials: W
authors.lastname: Messersmith
authors.affiliation: Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA.
authors.forename: Zhan
authors.initials: Z
authors.lastname: Ye
authors.affiliation: Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA.
authors.forename: Adedigbo A
authors.initials: AA
authors.lastname: Fasanmade
authors.affiliation: Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA.
authors.forename: Hadi
authors.initials: H
authors.lastname: Danaee
authors.affiliation: Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA.
authors.forename: Thea
authors.initials: T
authors.lastname: Kalebic
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D004943:Esophagogastric Junction / Q000473:pathology; D005260:Female; D006801:Humans; D018796:Immunoconjugates / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D000074261:Receptors, Enterotoxin / Q000276:immunology* / Q000378:metabolism; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D016896:Treatment Outcome; D047368:Tumor Burden / Q000187:drug effects
chemical_list: D000970:Antineoplastic Agents; D018796:Immunoconjugates; D000074261:Receptors, Enterotoxin
keywords: Antibody–drug conjugate; Gastrointestinal cancer; Guanylyl cyclase C; TAK-264