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SARC021 A Randomized Phase 3, Multicenter, Open- Label Study Comparing TH-302 in Combination with Doxorubicin vs. Doxorubicin Alone in Subjects with Locally Advanced Unresectable or Metastatic Soft Tissue Sarcoma PI: William Tap, MD Memorial Sloan-Kettering Cancer Center
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TH-302 Combination Therapy in Soft Tissue Sarcoma Phase 3 Study Design Collaborative Trial by Threshold Pharmaceuticals and Sarcoma Alliance for Research through Collaboration (SARC) Trial managed (including data management) by PAREXEL An Independent Data Monitoring Committee (IDMC) will monitor the safety and efficacy. (Ron Blum) An Independent Review Facility will be used to collect radiographs and may be used to independently evaluate tumor response and PFS
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3 Hypoxia Activated Prodrugs (HAPs) Hypoxia-activated prodrugs (HAPs) selectively target hypoxic tumor cells Hypoxia is a feature of solid tumors Associated with a worse prognosis Associated with an aggressive phenotype, invasiveness, metastasis, and relapse Often underlies treatment failure HAPs should complement conventional cancer therapies
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Chemotherapy Targets Oxygenated Tumor Compartment Vessels: Red Doxorubicin: Blue Hypoxia: Green Minchinton, A. and Tannock, I. Nat. Rev. Cancer. 6: 583-92, 2006 Mouse mammary tumor 4
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5 e.g. NADPH-cytochrome P450 reductase O 2 O 2 superoxide TH-302 Radical anion - Non-toxic prodrug reduced to radical anion (by 1e - reductase) - Back-oxidation to the original compound in presence of O 2 and production of superoxide - e.g. NADPH-cytochrome P450 reductase O 2 TH-302 - - Radical anion Hydroxyl amine Br-IPM Further reduction Fragmentation Chemistry Strategy for Targeting Hypoxia Hypoxia-Activated Prodrugs (HAPs)
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6 0% O 2 0.5% O 2 5% O 2 10% O 2 Blood vessel Normoxic zoneHypoxic zone TH-302Chemotherapy
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Waterfall Plot: Change in Target Lesion Diameters TH-302 + Doxorubicin in Soft Tissue Sarcoma The 403 Phase 1/2 Trial: 84% of Patients Experienced SD or Better (10/27/11)
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Phase 2 Response by Sarcoma Subtype Response rate (CR + PR): 36%
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TH-302 MAINTENANCE FOLLOWING TH-302 PLUS DOXORUBICIN INDUCTION: THE RESULTS OF A PHASE 2 STUDY OF TH-302 IN COMBINATION WITH DOXORUBICIN IN SOFT TISSUE SARCOMA Ganjoo KN 1, Cranmer LD 2, Van Tine B 3, Reed DR 4, Okuno SH 5, Butrynski JE 6, Adkins D 3, Hendifar A 7, Chu ED 8, Kroll SM 8, Chawla SP 7 1. Stanford University Medical Center, Stanford, CA, USA; 2. Arizona Cancer Center, Tucson, AZ, USA; 3. Washington University, St. Louis, MO, USA; 4. H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; 5. Mayo Clinic, Rochester, MN, USA; 6. Dana-Farber Cancer Institute, Boston, MA, USA; 7. Sarcoma Oncology Center, Santa Monica, CA, USA; 8. Threshold Pharmaceuticals, South San Francisco, CA, USA. Update on Overall Survival of 91 pts and Maintenance of 48 pts
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TH-302 Maintenance in Soft Tissue Sarcoma- Response Rates Response Rates: Overall response rate for 48 subjects receiving maintenance was 44% prior to receiving maintenance and 54% including both induction and maintenance. During the maintenance portion of the study 6 subjects had an upgrade in response category: 5 SDs converting to PR 1 PR converting to CR Table 5: Best Response (Unconfirmed) to Overall Treatment All (N=91*) Maintenance after Induction (N=48) Maintenance (N=48) Best Response Complete Response2 (2%)1 (2%)2 (4%) Partial Response30 (34%)20 (42%)24 (50%) Stable Disease43 (48%)27 (56%)22 (46%) Progressive Disease14(16%)0 (0%) Overall Response Rate (RR) (Partial Response + Complete Response)32 (36%)21 (44%)26(54%) * Two patients discontinued with reason subject decision (1) and PI decision (1) prior to initial tumor response assessment.
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TH-302 Maintenance in Soft Tissue Sarcoma- Progression-free Survival Figure 1B: Progression-free Survival after Initiating Maintenance (N=48) Progression-free Survival: The median PFS on study was 6.7 months (95% CI: 6.2 to 7.8 months). Figure 1A. The median PFS after TH-302 maintenance was 3.7 months (95% CI: 2.5 to 5.5 months). Figure1B. Figure 1A: Progression-free Survival on Study (N=91)
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SARC021 Schema Eligible Patients (N=450) ≥ 15 Years of Age Locally Advanced Unresectable or Metastatic Soft Tissue Sarcoma Stratification/Randomization TH-302 + Doxorubicin 21 Day Cycle Day 1 = TH-302 (300 mg/m 2 ) and Doxorubicin (75 mg/m 2 ) Day 8 = Th-302 (300 mg/m 2 ) and Day 8 or Day 9 = G-CSF Doxorubicin 21 Day Cycle Day 1 = Doxorubicin (75 mg/m 2 ) Response evaluations end of cycles 2, 4 and 6 until progression or discontinuation Note: Patient continues monotherapy TH-302 maintenance after cycle 6 without doxorubicin and G-CSF until discontinuation Response evaluations end of cycles 2, 4 and 6 until progression or discontinuation Note: Patient is discontinued after cycle 6 Survival Follow-up
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TH-302 Combination Therapy in Soft Tissue Sarcoma Phase 3 Study Status Approximately 25% of 450 subjects enrolled Approximately 50% of planned sites now active Sites open in Belgium, Canada, Germany, Israel, Italy, Hungary, Poland, Spain and United States Sites soon to open in Austria, Denmark, France and Russia Initial PFS futility analysis (113 events) projected to occur in 2 nd quarter of 2013 Enrollment on schedule to be completed by end of 2013 Initial OS interim for early efficacy stoppage (175 deaths) projected for end of 2013 Primary analysis (323 deaths) projected for end of 2014/beginning of 2015
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Thank You William Tap, MD Memorial Sloan-Kettering Cancer Ctr/SARC P: 646-888-4163 tapw@mskcc.org Denise Reinke, MS, NP SARC P: 734-930-7600 dreinke@sarctrials.org Clarence Eng Threshold P: 650-474-8222 ceng@thresholdpharm.com Katherine Randolph PAREXEL International P:858-487-8259 Katherine.Randolph@parexel.com 14 Who to contact if interested or with questions:
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