RESUMO
BACKGROUND: FGFR genomic aberrations occur in approximately 5-10% of human cancers. Erdafitinib has previously demonstrated efficacy and safety in FGFR-altered advanced solid tumors, such as gliomas, thoracic, gastrointestinal, gynecological, and other rare cancers. However, its efficacy and safety in Asian patients remain largely unknown. We conducted a multicenter, open-label, single-arm phase IIa study of erdafitinib to evaluate its efficacy in Asian patients with FGFR-altered advanced cholangiocarcinoma, non-small cell lung cancer (NSCLC), and esophageal cancer. METHODS: Patients with pathologically/cytologically confirmed, advanced, or refractory tumors who met molecular and study eligibility criteria received oral erdafitinib 8 mg once daily with an option for pharmacodynamically guided up-titration to 9 mg on a 28-day cycle, except for four NSCLC patients who received erdafitinib 10 mg (7 days on/7 days off) as they were recruited before the protocol amendment. The primary endpoint was investigator-assessed objective response rate per RECIST v1.1. Secondary endpoints included progression-free survival, duration of response, disease control rate, overall survival, safety, and pharmacokinetics. RESULTS: Thirty-five patients (cholangiocarcinoma: 22; NSCLC: 12; esophageal cancer: 1) were enrolled. At data cutoff (November 19, 2021), the objective response rate for patients with cholangiocarcinoma was 40.9% (95% CI, 20.7-63.6); the median progression-free survival was 5.6 months (95% CI, 3.6-12.7) and median overall survival was 40.2 months (95% CI, 12.4-not estimable). No patient with RET/FGFR-altered NSCLC achieved objective response and the disease control rate was 25.0% (95% CI, 5.5-57.2%), with three patients with stable disease. The single patient with esophageal cancer achieved partial response. All patients experienced treatment-emergent adverse events, and grade ≥ 3 treatment-emergent adverse events were reported in 22 (62.9%) patients. Hyperphosphatemia was the most frequently reported treatment-emergent adverse event (all-grade, 85.7%). CONCLUSIONS: Erdafitinib demonstrated efficacy in a population of Asian patients in selected advanced solid tumors, particularly in those with advanced FGFR-altered cholangiocarcinoma. Treatment was tolerable with no new safety signals. TRIAL REGISTRATION: This trial is registered with ClinicalTrials.gov (NCT02699606); study registration (first posted): 04/03/2016.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Colangiocarcinoma , Pirazóis , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Colangiocarcinoma/tratamento farmacológico , Colangiocarcinoma/genética , Colangiocarcinoma/patologia , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/patologia , Pirazóis/uso terapêutico , Pirazóis/administração & dosagem , Pirazóis/efeitos adversos , Adulto , Quinoxalinas/uso terapêutico , Quinoxalinas/administração & dosagem , Quinoxalinas/efeitos adversos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/genética , Receptores de Fatores de Crescimento de Fibroblastos/antagonistas & inibidores , Receptores de Fatores de Crescimento de Fibroblastos/genética , Povo Asiático , Neoplasias dos Ductos Biliares/tratamento farmacológico , Neoplasias dos Ductos Biliares/patologia , Intervalo Livre de Progressão , Idoso de 80 Anos ou maisRESUMO
Biotic (e.g., heavy metal) and abiotic stress (e.g., insect attack) can affect plant chemical defense, but little is known about the changes in plant defense when they occur concurrently. Herein, the impacts of heavy metal cadmium (Cd) stress and insect herbivory stress on the direct and indirect defense of two cultivar cabbages of Brassica campestris, the low-Cd cultivar Lvbao701 and the high-Cd cultivar Chicaixin No.4, against the herbivore cutworm Spodoptera litura were investigated. Although 10 mg kg-1 Cd stress alone inhibited leaf secondary metabolites (total phenolics, flavonoids), it reduced the feeding rate and odor selection of S. litura towards both cultivar cabbages, especially for Lvbao701, by increasing leaf Cd content and repellent volatile organic compounds (VOCs) (6-methyl-5-hepten-2-one, 7,9-di-tert-butyl-1-oxaspiro (4,5)deca-6,9-diene-2,8-dione), and reducing soluble sugar and attractive VOCs (3-methyl-3-pentanol, 2,5-hexanedione, tetradecanal). Under 2.5 mg kg-1 Cd and herbivory stress, although leaf total phenolics and flavonoids increased significantly, the feeding rate and odor selection of S. litura towards both cultivar cabbages increased, especially for Chicaixin No.4, indicating that the chemical defense of cabbages was depressed. Therefore, Cd stress alone improved the insect resistance of cabbages, whereas herbivory stress weakened the enhanced cabbages defence by Cd stress. The low-Cd cultivar Lvbao701 presented stronger insect resistance than Chicaixin No.4, suggesting that Lvbao701 application in Cd-polluted soil can not only decrease Cd transmission to higher levels in the food chain but also reduce pest occurrence.