Novel PD-1 inhibitor prolgolimab: expanding non-resectable/metastatic melanoma therapy choice
Sergey Tjulandin, Lev Demidov, Vladimir Moiseyenko, Svetlana Protsenko, Tatiana Semiglazova, Svetlana Odintsova, Ruslan Zukov, Sergey Lazarev, Yuliya Makarova, Marina Nechaeva, Dina Sakaeva, Aleksey Andreev, Anna Tarasova, Natalya Fadeyeva, Mariia Shustova, Ivan Kuryshev, Sergey Tjulandin, Lev Demidov, Vladimir Moiseyenko, Svetlana Protsenko, Tatiana Semiglazova, Svetlana Odintsova, Ruslan Zukov, Sergey Lazarev, Yuliya Makarova, Marina Nechaeva, Dina Sakaeva, Aleksey Andreev, Anna Tarasova, Natalya Fadeyeva, Mariia Shustova, Ivan Kuryshev
Abstract
Background: Prolgolimab is an IgG1 anti-PD-1 (programmed cell death protein 1) monoclonal antibody containing the Fc-silencing 'LALA' mutation. We assessed the efficacy and safety of two dosing regimens of prolgolimab in patients with advanced melanoma in a multicenter open-label parallel-arm phase II trial (MIRACULUM). We present the final analysis after 1 year of follow-up and additional efficacy results from 2 years of follow-up.
Methods: Patients with advanced cutaneous or non-cutaneous melanoma, including stable brain metastasis, without autoimmune disease and who underwent no prior targeted therapy, anti-PD-(L)1 or anti-CTLA-4 (cytotoxic T-lymphocyte-associated protein 4) therapy were randomly assigned (1:1) to receive prolgolimab in 2 dosing regimens, 1 mg/kg every 2 weeks (arm 1) or 3 mg/kg every 3 weeks (arm 2), until disease progression or intolerable toxicity. Randomisation was stratified based on performance status (Eastern Cooperative Oncology Group 0 or 1), lactate dehydrogenase levels (elevated or normal) and prior systemic therapy (naive or previously treated). The primary outcome was the objective response rate, assessed as per immune-related Response Evaluation Criteria in Solid Tumours by independent central review. The hypothesis that each dosing regimen of prolgolimab has an overall response rate >28% was tested independently for each study arm comprising all patients who received at least one dose of prolgolimab. Exploratory assessment of efficacy, including subgroup analysis, at 2 years of follow-up was not specified in the protocol. This study is registered withClinicalTrials.gov(NCT03269565).
Results: Between August 2017 and March 2018, 126 patients with advanced melanoma were enrolled. At main 1-year data cut-off, the median follow-up was 13.8 and 14.5 months in arm 1 and 2, respectively. An objective response was observed in 38.1% of patients (arm 1) and in 28.6% (arm 2). Grade III-IV treatment-related adverse events occurred in 12.7% and 3.2% of patients in arm 1 and 2, respectively. For exploratory efficacy analysis, the median follow-up was 25.4 and 25.7 months in arm 1 and 2, respectively. The 2-year progression-free survival was 33.3% in arm 1 and 30.2% in arm 2, and the 2-year overall survival was 57.1% and 46.0%, respectively.
Conclusions: The MIRACULUM study met its primary end-point in both the study arms. Prolgolimab showed significant antitumour activity and a manageable safety profile in patients with advanced melanoma.
Keywords: Anti–PD-1; Immunotherapy; Melanoma; Prolgolimab.
Conflict of interest statement
Conflict of interest statement M.N., N.F., R.Z., S.L., S.T., S.O., S.P., T.S., V.M., Y.M., A.T., D.S., L.D. and A.A. report clinical trial investigator's fee (MIRACULUM) and honoraria from BIOCAD for participation as a speaker at scientific and educational meetings. M.S. and K.I. are BIOCAD employees.
Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Source: PubMed