Lenvatinib Plus PD-1 Inhibitors as First-Line Treatment in Patients With Unresectable Biliary Tract Cancer: A Single-Arm, Open-Label, Phase II Study

Qiyi Zhang; Xingyu Liu; Shumei Wei; Lufei Zhang; Yang Tian; Zhenzhen Gao; Ming Jin; Sheng Yan

doi:10.3389/fonc.2021.751391

Lenvatinib Plus PD-1 Inhibitors as First-Line Treatment in Patients With Unresectable Biliary Tract Cancer: A Single-Arm, Open-Label, Phase II Study

Front Oncol. 2021 Nov 24:11:751391. doi: 10.3389/fonc.2021.751391. eCollection 2021.

Authors

Qiyi Zhang^{1

2}, Xingyu Liu^{1

2}, Shumei Wei³, Lufei Zhang^{1

2}, Yang Tian^{1

2}, Zhenzhen Gao^{1

2}, Ming Jin^{1

2}, Sheng Yan^{1

2}

Affiliations

¹ Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.
² Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China.
³ Department of Pathology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.

Abstract

Objective: We investigated lenvatinib plus programmed cell death-1 (PD-1) inhibitors as a first-line treatment for initially unresectable biliary tract cancer (BTC).

Methods: In this Phase II study, adults with initially unresectable BTC received lenvatinib (body weight ≥60 kg, 12 mg; <60 kg, 8 mg) daily and PD-1 inhibitors (pembrolizumab/tislelizumab/sintilimab/camrelizumab 200 mg or toripalimab 240 mg) every 3 weeks. Primary endpoints were objective response rate (ORR) and safety. Secondary endpoints included surgical conversion rate, disease control rate (DCR), event-free survival (EFS), overall survival (OS) and tumor biomarkers.

Results: Among 38 enrolled patients, the ORR was 42.1% and the DCR was 76.3%. Thirteen (34.2%) patients achieved downstaging and underwent surgery, six of whom (46.2%) achieved a major pathologic response (n=2) or partial pathologic response (n=4) in the primary tumor. In total, 84.2% of patients experienced ≥1 treatment-related adverse event (TRAE), 34.2% experienced a Grade ≥3 TRAE and no treatment-related deaths occurred. After a median follow-up of 13.7 months the median EFS was 8.0 months (95% CI: 4.6-11.4) and the median OS was 17.7 months (95% CI: not estimable).

Conclusions: Lenvatinib plus PD-1 inhibitors showed promising anti-tumor efficacy in patients with initially unresectable BTC and was generally well tolerated.

Clinical trial registration: www.chictr.org.cn, ChiCTR2100044476.

Keywords: PD-1 inhibitors; biliary tract cancer; conversion surgery; first-line treatment; lenvatinib.