IOLite: phase 1b trial of doublet/triplet combinations of dostarlimab with niraparib, carboplatin-paclitaxel, with or without bevacizumab in patients with advanced cancer

Abstract

Background: Doublet combination therapies targeting immune checkpoints have shown promising efficacy in patients with advanced solid tumors, but it is unknown if rational triplet combinations will be well tolerated and associated with improved antitumor activity. The objective of this trial was to determine the recommended phase 2 doses (RP2Ds) and to assess the safety and efficacy of the programmed cell death protein 1 (PD-1) inhibitor dostarlimab in combination with (1) the poly(ADP-ribose) polymerase inhibitor niraparib with or without vascular endothelial growth factor inhibitor bevacizumab or (2) carboplatin-paclitaxel chemotherapy with or without bevacizumab, in patients with advanced cancer.

Methods: IOLite is a multicenter, open-label, multi-arm clinical trial. Patients with advanced solid tumors were enrolled. Patients received dostarlimab in combination with niraparib with or without bevacizumab or in combination with carboplatin-paclitaxel with or without bevacizumab until disease progression, unacceptable toxicity, or withdrawal from the study. Prespecified endpoints in all parts were to evaluate the dose-limiting toxicities (DLTs), RP2Ds, pharmacokinetics (PKs), and preliminary efficacy for each combination.

Results: A total of 55 patients were enrolled; patients received dostarlimab and: (1) niraparib in part A (n=22); (2) carboplatin-paclitaxel in part B (n=14); (3) niraparib plus bevacizumab in part C (n=13); (4) carboplatin-paclitaxel plus bevacizumab in part D (n=6). The RP2Ds of all combinations were determined. All combinations were safe and tolerable, with no new safety signals observed. DLTs were reported in 2, 1, 2, and 0 patients, in parts A-D, respectively. Preliminary antitumor activity was observed, with confirmed Response Evaluation Criteria in Solid Tumors v1.1 complete/partial responses reported in 4 of 22 patients (18.2%), 6 of 14 patients (42.9%), 4 of 13 patients (30.8%), and 3 of 6 (50.0%) patients, in parts A-D, respectively. Disease control rates were 40.9%, 57.1%, 84.6%, and 83.3%, in parts A-D, respectively. Dostarlimab PK was unaffected by any combinations tested. Coadministration of bevacizumab showed no impact on niraparib PKs. The overall mean PD-1 receptor occupancy was 99.0%.

Conclusions: Dostarlimab was well tolerated in both doublet and triplet regimens tested, with promising antitumor activity observed with all combinations. We observed higher disease control rates in the triplet regimens than in doublet regimens.

Trial registration number: NCT03307785.

Keywords: Clinical Trials as Topic; Drug Therapy, Combination; Immunotherapy; Programmed Cell Death 1 Receptor.

Conflict of interest statement

Competing interests: TAY has received research support to the institution from Artios, AstraZeneca, Bayer, Clovis, Constellation, Cyteir, Eli Lilly, EMD Serono, Forbius, F-Star, Genentech, GlaxoSmithKline, ImmuneSensor, Ipsen, Jounce, Karyopharm, Kyowa, Merck, Novartis, Pfizer, Regeneron, Repare, Ribon Therapeutics, Sanofi, Scholar Rock, Seattle Genetics, Tesaro, and Vertex Pharmaceuticals; and has served as a consultant for Aduro, Almac, AstraZeneca, Atrin, Axiom, Bayer, Bristol Myers Squibb, Calithera, Clovis, Cybrexa, EMD Serono, F-Star, Guidepoint, Ignyta, I-Mab, Janssen, Merck, Pfizer, Repare, Roche, Rubius, Schrodinger, Seattle Genetics, Varian, and Zai Labs. AB has nothing to disclose. EPH reports institutional research or clinical trial support from Seattle Genetics, Puma, AstraZeneca, Hutchinson MediPharma, OncoMed, MedImmune, StemCentrx, Genentech/Roche, Curis, Verastem, Zymeworks, Syndax, Lycera, Rgenix, Novartis, Mersana, Millenium, TapImmune, Lilly, BerGenBio, Medivation, Pfizer, Tesaro, Boehringer Ingelheim, Eisai, H3 Biomedicine, Radius Health, Acerta, Takeda, Macrogenics, AbbVie, Immunomedics, FujiFilm, Effector, Merus, Nucana, Regeneron, Leap Therapeutics, Taiho Pharmaceutical, EMD Serono, Daiichi Sankyo, ArQule, Syros, Clovis, Cytomx, InventisBio, Deciphera, Unum Therapeutics, Sermonix Pharmaceuticals, Sutro, Aravive, Zenith Epigenetics, Arvinas, Torque, Harpoon, Fochon, Black Diamond, Orinove, Molecular Templates, Silverback Therapeutics, Compugen, G1Therapeutics, Karyopharm Therapeutics and Torque Therapeutics, outside the submitted work. JS reports grants from Pfizer, Celgene, Genentech; personal fees from Celgene, PUMA, TTC Oncology, Pfizer, Novartis, TapImmune, Ipsen, Tempus, and AstraZeneca; and honoraria from Ipsen, Celgene, PUMA, Novartis, Pfizer, Tempus, and AstraZeneca; institutional research support from Pfizer, AbbVie, AstraZeneca, Verastem, Leap therapeutics, Endocyte, Cleave, Merck, Bayer, Exelixis, Medivation, Biomarin, Tesaro, TTC-Oncology, Genentech/Roche, Arqule, Syros, Sermonix, Black Diamond, Fujifilm, Arcus, Corcept, ImmuneSensor, Aduro, Agenus, Five Prime, Gilead, CytRx, Merrimack, Ipsen, Plexxikon, Proacta, Esanex, MiRNA, and BIND outside the submitted work. MRP reports funding from Tesaro/GSK during the conduct of the study; consulting fees from Janssen, EMD serono, Pfizer, Pharmacyclics, Bayer, and Genentech outside the submitted work. JRA reports personal fees from Novartis, Eli Lilly, Orion Pharmaceuticals, Servier Pharmaceuticals, Peptomyc, Merck Sharp & Dohme, Kelun Pharmaceuticals/Klus Pharma, Spectrum Pharmaceuticals, Pfizer, Roche Pharmaceuticals, Ellipses Pharma, Certera, Bayer, Molecular Partners, NovellusDX, IONCTURA SA; grants from Bayer, Novartis, Blueprint Pharmaceuticals, Spectrum Pharmaceuticals, Tocagen, Symphogen, BioAlta, Pfizer, GenMab, CytomX, Kelun-Biotech, Takeda-Millenium, GlaxoSmithKline, Ipsen; travel reimbursement from ESMO, Department of Defense, Merck Sharp & Dohme, Louisiana State University, Kelun Pharmaceuticals/Klus Pharma, Huntsman Cancer Institute, Cancer Core Europe, Karolinska Cancer Institute, King Abdullah International Medical Research Center, Bayer, WIN Consortium, Jansen, Molecular Partners; and other compensation from European Journal of Cancer, VHIO/Ministero De Empleo Y Seguridad Social, Chinese University of Hong Kong, SOLTI, Elsevier, GlaxoSmithKline, outside the submitted work. LE was an employee of GSK at the time the study was done. MD was an employee of GSK at the time the study was done. WG was an employee of GSK at the time the study was done. SK was an employee of GSK at the time the study was done. SL was an employee of GSK at the time the study was done. BJD was an employee of GSK at the time the study was done. NG has nothing to disclose.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

Patient enrollment by trial part. Parts A and C show the enrollment of new patients for niraparib dose escalation from 200 mg QD to 300 mg QD per 6+6 dose escalation rules. DLT, dose-limiting toxicity; QD, once daily.

Figure 2

Duration of response and treatment in part A (A), part B (B), part C (C), and part D (D). AC, appendix cancer; BC, breast cancer; BDC, bile duct cancer; BLC, bladder cancer; CAC, colon adenocarcinoma; CC, colon cancer; CCA, cholangiocarcinoma; CRC, colorectal cancer; EC, endometrial cancer; EOS, end of study; ESC, esophageal cancer; FTPC, fallopian tube papillary carcinoma; GC, gastrointestinal cancer; GIST, gastrointestinal stromal tumor; HNC, head and neck cancer; LC, liver cancer; LMS, leiomyosarcoma; NSCLC, non-small cell lung carcinoma; OC, ovarian cancer; PC, pancreatic cancer; PRC, prostate cancer; RC, rectal cancer; RECIST, Response Evaluation Criteria in Solid Tumors; SCC, squamous cell carcinoma; SCLC, small cell lung cancer; UC, uterine cancer; VC, vulvar cancer.

Figure 3

Best change in target lesion size in part A (A), part B (B), part C (C), and part D (D). AC, appendix cancer; BC, breast cancer; BDC, bile duct cancer; BLC, bladder cancer; CC, colon cancer; CCA, cholangiocarcinoma; CRC, colorectal cancer; EC, endometrial cancer; FTPC, fallopian tube papillary carcinoma; GC, gastrointestinal cancer; GIST, gastrointestinal stromal tumor; HNC, head and neck cancer; LC, liver cancer; LMS, leiomyosarcoma; NSCLC, non-small cell lung carcinoma; OC, ovarian cancer; PC, pancreatic cancer; PRC, prostate cancer; SCC, squamous cell carcinoma; SCLC, small cell lung cancer; UC, uterine cancer; VC, vulvar cancer.

Figure 4

Time plots of mean dostarlimab and niraparib serum pharmacokinetic concentration by treatment and cycle. Mean (±SD) dostarlimab serum concentration by treatment as semi-logarithmic curves for dostarlimab cycle 1 (A), dostarlimab cycle 5 (B), niraparib cycle 1 (C), and niraparib cycle 2 (D).