Efficacy and Safety of Avelumab Treatment in Patients with Advanced Unresectable Mesothelioma: Phase 1b Results from the JAVELIN Solid Tumor Trial

Raffit Hassan, Anish Thomas, John J. Nemunaitis, Manish R. Patel, Jaafar Bennouna, Franklin L. Chen, Jean Pierre Delord, Afshin Dowlati, Samith T. Kochuparambil, Matthew H. Taylor, John D. Powderly, Ulka N. Vaishampayan, Claire Verschraegen, Hans Juergen Grote, Anja Von Heydebreck, Kevin Chin, James L. Gulley

    Research output: Contribution to journalArticle

    17 Scopus citations

    Abstract

    Importance: Patients with malignant mesothelioma whose disease has progressed after platinum and pemetrexed treatment have limited options. Anti-programmed cell death 1 (PD-1) antibodies have antitumor activity in this disease, but little is known about the activity of anti-programmed cell death ligand 1 (PD-L1) antibodies in patients with mesothelioma. Objective: To assess the efficacy and safety of avelumab in a cohort of patients with previously treated mesothelioma. Design, Setting, and Participants: Phase 1b open-label study (JAVELIN Solid Tumor) in patients with unresectable mesothelioma that progressed after platinum and pemetrexed treatment, enrolled at 25 sites in 3 countries between September 9, 2014, and July 22, 2015. Interventions: Participants received avelumab, 10 mg/kg, every 2 weeks until disease progression, unacceptable toxic effects, or withdrawal from the study. Main Outcomes and Measures: Prespecified end points included confirmed best overall response based on Response Evaluation Criteria In Solid Tumors, version 1.1; duration of response; progression-free survival (PFS); overall survival (OS); PD-L1 expression-based analyses; and safety. Results: Of 53 patients treated with avelumab, the median age was 67 (range, 32-84) years; 32 (60%) were male. As of December 31, 2016, median follow-up was 24.8 (range, 16.8-27.8) months. Twenty patients (38%) had 3 or more previous lines of therapy (median, 2; range, 1-8). The confirmed objective response rate (ORR) was 9% (5 patients; 95% CI, 3.1%-20.7%), with complete response in 1 patient and partial response in 4 patients. Responses were durable (median, 15.2 months; 95% CI, 11.1 to not estimable months) and occurred in patients with PD-L1-positive tumors (3 of 16; ORR, 19%; 95% CI, 4.0%-45.6%) and PD-L1-negative tumors (2 of 27; ORR, 7%; 95% CI, 0.9%-24.3%) based on a 5% or greater PD-L1 cutoff. Disease control rate was 58% (31 patients). Median PFS was 4.1 (95% CI, 1.4-6.2) months, and the 12-month PFS rate was 17.4% (95% CI, 7.7%-30.4%). Median OS was 10.7 (95% CI, 6.4-20.2) months, and the median 12-month OS rate was 43.8% (95% CI, 29.8%-57.0%). Five patients (9%) had a grade 3 or 4 treatment-related adverse event, and 3 (6%) had a grade 3 or 4 immune-related, treatment-related adverse event. There were no treatment-related deaths. Conclusions and Relevance: Avelumab showed durable antitumor activity and disease control with an acceptable safety profile in a heavily pretreated cohort of patients with mesothelioma. Trial Registration: ClinicalTrials.gov identifier: NCT01772004.

    Original languageEnglish (US)
    Pages (from-to)351-357
    Number of pages7
    JournalJAMA Oncology
    Volume5
    Issue number3
    DOIs
    StatePublished - Mar 2019

    ASJC Scopus subject areas

    • Oncology
    • Cancer Research

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    Hassan, R., Thomas, A., Nemunaitis, J. J., Patel, M. R., Bennouna, J., Chen, F. L., Delord, J. P., Dowlati, A., Kochuparambil, S. T., Taylor, M. H., Powderly, J. D., Vaishampayan, U. N., Verschraegen, C., Grote, H. J., Von Heydebreck, A., Chin, K., & Gulley, J. L. (2019). Efficacy and Safety of Avelumab Treatment in Patients with Advanced Unresectable Mesothelioma: Phase 1b Results from the JAVELIN Solid Tumor Trial. JAMA Oncology, 5(3), 351-357. https://doi.org/10.1001/jamaoncol.2018.5428