Dostarlimab for Primary Advanced or Recurrent Endometrial Cancer.
Female
Humans
Antibodies, Monoclonal, Humanized
/ administration & dosage
Antineoplastic Combined Chemotherapy Protocols
/ adverse effects
Carboplatin
/ administration & dosage
DNA Mismatch Repair
Double-Blind Method
Endometrial Neoplasms
/ drug therapy
Immune Checkpoint Inhibitors
/ administration & dosage
Microsatellite Instability
Neoplasm Recurrence, Local
/ drug therapy
Paclitaxel
/ administration & dosage
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
08 06 2023
08 06 2023
Historique:
medline:
9
6
2023
pubmed:
28
3
2023
entrez:
27
3
2023
Statut:
ppublish
Résumé
Dostarlimab is an immune-checkpoint inhibitor that targets the programmed cell death 1 receptor. The combination of chemotherapy and immunotherapy may have synergistic effects in the treatment of endometrial cancer. We conducted a phase 3, global, double-blind, randomized, placebo-controlled trial. Eligible patients with primary advanced stage III or IV or first recurrent endometrial cancer were randomly assigned in a 1:1 ratio to receive either dostarlimab (500 mg) or placebo, plus carboplatin (area under the concentration-time curve, 5 mg per milliliter per minute) and paclitaxel (175 mg per square meter of body-surface area), every 3 weeks (six cycles), followed by dostarlimab (1000 mg) or placebo every 6 weeks for up to 3 years. The primary end points were progression-free survival as assessed by the investigator according to Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1, and overall survival. Safety was also assessed. Of the 494 patients who underwent randomization, 118 (23.9%) had mismatch repair-deficient (dMMR), microsatellite instability-high (MSI-H) tumors. In the dMMR-MSI-H population, estimated progression-free survival at 24 months was 61.4% (95% confidence interval [CI], 46.3 to 73.4) in the dostarlimab group and 15.7% (95% CI, 7.2 to 27.0) in the placebo group (hazard ratio for progression or death, 0.28; 95% CI, 0.16 to 0.50; P<0.001). In the overall population, progression-free survival at 24 months was 36.1% (95% CI, 29.3 to 42.9) in the dostarlimab group and 18.1% (95% CI, 13.0 to 23.9) in the placebo group (hazard ratio, 0.64; 95% CI, 0.51 to 0.80; P<0.001). Overall survival at 24 months was 71.3% (95% CI, 64.5 to 77.1) with dostarlimab and 56.0% (95% CI, 48.9 to 62.5) with placebo (hazard ratio for death, 0.64; 95% CI, 0.46 to 0.87). The most common adverse events that occurred or worsened during treatment were nausea (53.9% of the patients in the dostarlimab group and 45.9% of those in the placebo group), alopecia (53.5% and 50.0%), and fatigue (51.9% and 54.5%). Severe and serious adverse events were more frequent in the dostarlimab group than in the placebo group. Dostarlimab plus carboplatin-paclitaxel significantly increased progression-free survival among patients with primary advanced or recurrent endometrial cancer, with a substantial benefit in the dMMR-MSI-H population. (Funded by GSK; RUBY ClinicalTrials.gov number, NCT03981796.).
Sections du résumé
BACKGROUND
Dostarlimab is an immune-checkpoint inhibitor that targets the programmed cell death 1 receptor. The combination of chemotherapy and immunotherapy may have synergistic effects in the treatment of endometrial cancer.
METHODS
We conducted a phase 3, global, double-blind, randomized, placebo-controlled trial. Eligible patients with primary advanced stage III or IV or first recurrent endometrial cancer were randomly assigned in a 1:1 ratio to receive either dostarlimab (500 mg) or placebo, plus carboplatin (area under the concentration-time curve, 5 mg per milliliter per minute) and paclitaxel (175 mg per square meter of body-surface area), every 3 weeks (six cycles), followed by dostarlimab (1000 mg) or placebo every 6 weeks for up to 3 years. The primary end points were progression-free survival as assessed by the investigator according to Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1, and overall survival. Safety was also assessed.
RESULTS
Of the 494 patients who underwent randomization, 118 (23.9%) had mismatch repair-deficient (dMMR), microsatellite instability-high (MSI-H) tumors. In the dMMR-MSI-H population, estimated progression-free survival at 24 months was 61.4% (95% confidence interval [CI], 46.3 to 73.4) in the dostarlimab group and 15.7% (95% CI, 7.2 to 27.0) in the placebo group (hazard ratio for progression or death, 0.28; 95% CI, 0.16 to 0.50; P<0.001). In the overall population, progression-free survival at 24 months was 36.1% (95% CI, 29.3 to 42.9) in the dostarlimab group and 18.1% (95% CI, 13.0 to 23.9) in the placebo group (hazard ratio, 0.64; 95% CI, 0.51 to 0.80; P<0.001). Overall survival at 24 months was 71.3% (95% CI, 64.5 to 77.1) with dostarlimab and 56.0% (95% CI, 48.9 to 62.5) with placebo (hazard ratio for death, 0.64; 95% CI, 0.46 to 0.87). The most common adverse events that occurred or worsened during treatment were nausea (53.9% of the patients in the dostarlimab group and 45.9% of those in the placebo group), alopecia (53.5% and 50.0%), and fatigue (51.9% and 54.5%). Severe and serious adverse events were more frequent in the dostarlimab group than in the placebo group.
CONCLUSIONS
Dostarlimab plus carboplatin-paclitaxel significantly increased progression-free survival among patients with primary advanced or recurrent endometrial cancer, with a substantial benefit in the dMMR-MSI-H population. (Funded by GSK; RUBY ClinicalTrials.gov number, NCT03981796.).
Identifiants
pubmed: 36972026
doi: 10.1056/NEJMoa2216334
doi:
Substances chimiques
Antibodies, Monoclonal, Humanized
0
Carboplatin
BG3F62OND5
dostarlimab
0
Immune Checkpoint Inhibitors
0
Paclitaxel
P88XT4IS4D
Banques de données
ClinicalTrials.gov
['NCT03981796']
Types de publication
Randomized Controlled Trial
Clinical Trial, Phase III
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2145-2158Subventions
Organisme : NCI NIH HHS
ID : UG1 CA233339
Pays : United States
Investigateurs
Mikalai Pishchyk
(M)
Christine Gennigens
(C)
Greet Huygh
(G)
Lucy Gilbert
(L)
Vanessa Samouelian
(V)
Johanne Weberpals
(J)
Alexandra Sebastianelli
(A)
Ioannis Voutsadakis
(I)
David Cibula
(D)
Mansoor Mirza
(M)
Adam Andrzej Luczak
(AA)
Nicoline Raaschou-Jensen
(N)
Trine Lembrecht Jørgensen
(TL)
Lene Weber-Vestermark
(L)
Jørn Herrstedt
(J)
Annika Auranen
(A)
Sakari Hietanen
(S)
Maarit Anttila
(M)
Marjo Tuppurainen
(M)
Martina Gropp-Meier
(M)
Andreas Hartkopf
(A)
Eva-Maria Grischke
(EM)
Lars Hanker
(L)
Antje Lehnert
(A)
Dirk Bauerschlag
(D)
Dominik Denschlag
(D)
Beyhan Ataseven
(B)
Thomas Papathemelis
(T)
George Fountzilas
(G)
Andrea Bagaméri
(A)
Daliah Tsoref
(D)
Tamar Safra
(T)
Mihai Meirovitz
(M)
Yakir Segev
(Y)
Shani Breuer
(S)
Francesco Raspagliesi
(F)
Graziana Ronzino
(G)
Giorgio Valabrega
(G)
Elena Geuna
(E)
Antonella Savarese
(A)
Fabrizio Artioli
(F)
Laura Lombardo
(L)
Laura Zavallone
(L)
Massimiliano Nicolini
(M)
Roberto Angioli
(R)
Ingrid Boere
(I)
Roy Lalisang
(R)
Anna Reyners
(A)
Machteld Wymenga
(M)
Annemarie Thijs
(A)
Line Bjørge
(L)
Kristina Lindemann
(K)
Elisabeth Berge Nilsen
(E)
Anne Gry Bentzen
(AG)
Guro Aune
(G)
Aneta Cymbaluk-Płoska
(A)
Beata Maćkowiak-Matejczyk
(B)
Caroline Lundgren
(C)
Magnus Frödin-Bolling
(M)
Rebecca Kristeleit
(R)
Anthoula Koliadi
(A)
Gabriel Lindahl
(G)
Fuat Demirkiran
(F)
Ilhan Hacibekiroglu
(I)
Mehmet Coskun Salman
(MC)
Levent Yasar
(L)
Vladyslav Sukhin
(V)
Oleksandr Zub
(O)
Joo Ern Ang
(JE)
Gemma Eminowicz
(G)
Rebecca Herbertson
(R)
Steven Waggoner
(S)
Amy Armstrong
(A)
Robert Morris
(R)
Radhika Gogoi
(R)
David Bender
(D)
Guilherme Cantuaria
(G)
Christina Chu
(C)
Michael Callahan
(M)
Mark S Shahin
(MS)
Patricia Braly
(P)
Tashanna Myers
(T)
Cara Mathews
(C)
Robert Holloway
(R)
Kari Ring
(K)
Nicole Nevadunsky
(N)
Bhavana Pothuri
(B)
Elisabeth Driver
(E)
Jonathan Berek
(J)
Sarah Gill
(S)
Matthew Schlumbrecht
(M)
Oladapo Yeku
(O)
Sara Bouberhan
(S)
Matthew Powell
(M)
Kathryn Pennington
(K)
Angeles Secord
(A)
Sudarshan Sharma
(S)
Michael Teneriello
(M)
Helen Eshed
(H)
Rachel Miller
(R)
Evelyn Fleming
(E)
Carolyn Matthews
(C)
Brandon Sawyer
(B)
David Iglesias
(D)
Eirwen Miller
(E)
Caroline Billingsley
(C)
Joyce Barlin
(J)
Destin Black
(D)
Julian Schink
(J)
Barbara Buttin
(B)
Kellie Schneider
(K)
Jonathan Boone
(J)
Michael A Gold
(MA)
Jeanne Schilder
(J)
Paul Mayor
(P)
Lisa Landrum
(L)
Paul Nowicki
(P)
Sharad Ghamande
(S)
Dana Chase
(D)
Joseph Buscema
(J)
Noelle Cloven
(N)
John Diaz
(J)
Alberto Mendivil
(A)
Iwona Podzielinski
(I)
Joshua Trinidad
(J)
Floor Backes
(F)
Commentaires et corrections
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