Infigratinib versus gemcitabine plus cisplatin multicenter, open-label, randomized, phase 3 study in patients with advanced cholangiocarcinoma with FGFR2 gene fusions/translocations: The PROOF trial.

Abstract

TPS4155 Background: Cholangiocarcinoma is the most common biliary tract malignancy with approximately 5,000–10,000 new cases annually in the USA. The fibroblast growth factor receptor (FGFR) family plays an important role in cholangiocarcinoma, with FGFR2 gene fusions detected in about 15% of patients with cholangiocarcinoma. Infigratinib is an ATP-competitive, FGFR1–3-selective oral tyrosine kinase inhibitor. First-line treatment with chemotherapy offers only modest benefit and more effective treatment options are needed. Based on preliminary response data of infigratinib in relapsed/refractory cholangiocarcinoma with FGFR2 fusions/translocations (Phase 2 Study CBJG398X2204), the PROOF trial is evaluating infigratinib versus gemcitabine + cisplatin in front-line patients with advanced cholangiocarcinoma with FGFR2 gene fusions/translocations. Methods: Patients with advanced/metastatic or inoperable cholangiocarcinoma are randomized 1:1 to oral infigratinib once daily for 21 days of a 28-day treatment cycle versus IV gemcitabine (1000 mg/m2) + cisplatin (25 mg/m2) on days 1 and 8 of a 21-day cycle. Treatment will continue until confirmed progressive disease by central review, intolerance, withdrawal of informed consent, or death. After 8 cycles of gemcitabine + cisplatin, patients can continue treatment if the investigator considers that they are deriving continued benefit. Patients on the gemcitabine + cisplatin arm who progress can cross-over to infigratinib. The primary endpoint is progression-free survival (PFS, per RECIST v1.1 central review). Secondary endpoints include overall survival, PFS (investigator determined), overall response rate, disease control rate, duration of response, and safety. Quality of life, PK and exploratory genetic alterations/biomarkers will also be measured. Current status: The study was initiated in February 2019 with planned enrollment of 350 patients with confirmed FGFR2 gene fusions/translocations. Clinical trial information: NCT03773302.

Current and novel therapeutic opportunities for systemic therapy in biliary cancer

“…Currently there are several FGFR inhibitors that differ with respect to their toxicity and specificity through the target range (FGFR1-4 ) under clinical investigation, including Debio 1347, TAS-120/Futibatinib and erdafitinib (42,43,(45)(46)(47)(48) (Table 1). Infigratinib, pemigatinib and futibatinib have progressed to phase III evaluation as first-line single agents versus the standard of care GEM/CIS (ClinicalTrials.gov: NCT03773302, NCT03656536, NCT04093362), with the trial results eagerly awaited (49).…”

In vivo modelling of patient genetic heterogeneity identifies concurrent Wnt and PI3K activity as a potent driver of invasive cholangiocarcinoma growth

“…Despite their identification, the presence of these mutations in a tumour is not a strong predictor of therapeutic outcome (17)(18)(19) and for approximately 30% of ICC patients a driver mutation cannot be identified (20,21).…”

Current and Future Systemic Therapies in Biliary Tract Cancer

“…Currently, several FGFR inhibitors have been entered into phase III trials. Since early 2019, the randomized trial “PROOF” has been recruiting patients in the first line for treatment with infigratinib versus GemCis (and possible crossover into the infigratinib arm) [33]. In addition, pemigatinib is further developed in first line in comparison to standard of care (GemCis) in the FIGHT-302 study (NCT03656536) [34], whereas derazantinib is evaluated in the FIDES-01 study in second line (NCT03230318).…”