Treatment-related adverse events as predictive biomarkers of efficacy in patients with advanced neuroendocrine tumors treated with surufatinib: results from two phase III studies

J Li, Y Cheng, C Bai, J Xu, L Shen, J Li, Z Zhou, Z Li, Y Chi, X Yu, E Li, N Xu, T Liu, W Lou, Y Bai, X Yuan, X Wang, Y Yuan, J Chen, S Guan, S Fan, W Su, J Li, Y Cheng, C Bai, J Xu, L Shen, J Li, Z Zhou, Z Li, Y Chi, X Yu, E Li, N Xu, T Liu, W Lou, Y Bai, X Yuan, X Wang, Y Yuan, J Chen, S Guan, S Fan, W Su

Abstract

Background: No validated biomarkers currently exist for predicting the efficacy outcomes in patients with neuroendocrine tumors (NETs) treated with antiangiogenic therapy. We aimed to evaluate the association between treatment-related adverse events (TRAEs) and efficacy outcomes of surufatinib in patients with advanced NET.

Patients and methods: We included patients with NET treated with surufatinib in two multicenter, randomized, double-blind, placebo-controlled, phase III trials (SANET-p and SANET-ep) in this study. The main exposure was the presence of any of the TRAEs including hypertension, proteinuria, and hemorrhage in the first 4 weeks of surufatinib treatment. The primary outcome of the study was investigator-assessed progression-free survival (PFS). PFS outcomes were estimated using the Kaplan-Meier method with the log-rank test. Hazard ratios (HRs) were calculated by using univariable and multivariable Cox proportional hazard regression models. Blinded independent image review committee (BIIRC) assessments and 4-week landmark analysis were also performed as supportive evaluations.

Results: During the study period, a total of 242 patients treated with surufatinib were included in the analysis, and 164 (68%) patients had at least one of hypertension, proteinuria, and hemorrhage in the first 4 weeks of treatment. The presence of TRAEs in the first 4 weeks was associated with prolonged median PFS [11.1 versus 9.2 months; HR 0.67, 95% confidence interval (CI) 0.47-0.97; P = 0.036]. In multivariable Cox regression analysis, the presence of TRAEs was also significantly associated with longer PFS (HR 0.65, 95% CI 0.44-0.97; P = 0.035). Similar results were obtained in the BIIRC assessments and 4-week landmark analysis.

Conclusions: Treatment-related hypertension, proteinuria, and hemorrhage could be potential biomarkers to predict antitumor efficacy of surufatinib in patients with advanced NET. Future prospective studies are needed to validate the findings.

Trial registration: ClinicalTrials.govNCT02589821; https://ichgcp.net/clinical-trials-registry/NCT02589821 and ClinicalTrials.gov NCT02588170; https://ichgcp.net/clinical-trials-registry/NCT02588170.

Keywords: SANET; adverse event; biomarker; neuroendocrine tumor; surufatinib.

Conflict of interest statement

Disclosure The authors declare no competing interests. Data sharing The data of patients used in this study are available from the corresponding author upon reasonable request. Consent for publication Not applicable. Ethics approval and consent to participate The study protocol, amendments, and informed consent forms were approved by the institutional review board or ethics committee of each participating center.

Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1
Figure 1
Kaplan–Meier curve of investigator-assessed progression-free survival by presence of treatment-related adverse events in the first 4 weeks of surufatinib treatment. AEs, adverse events; CI, confidence interval.

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