Abstract CT159: CYCLONE 1: abemaciclib in men with heavily pretreated metastatic castration-resistant prostate cancer (mCRPC)
Authors: Agarwal Neeraj , Guana Daniel Castellano , Gordoa Teresa A. , Arija Jose A. , Colomba Emeline , Gravis Gwenaelle , Mourey Loic , Oudard Stephanie , Flechon Aude , Gonzalez Macarena , Maroto-Rey Pablo , Schweizer Michael , Gallardo Enrique , Nacerddine Karim , Appiach Adams K. , Balar Arjun , Johnston Erica , Piulats José M. 
Published: April 2023

Background: Treatment options for patients (pts) with heavily pretreated mCRPC are limited. Augmenting endocrine therapy by targeting CDK4/6 with abemaciclib has dramatically improved outcomes in HR+ breast cancer. Similar to ER, AR signaling activates CDK4 & 6 and abemaciclib showed preclinical anti-tumor activity in prostate cancer (PC). This signal seeking single arm Phase 2 study evaluated the safety and clinical activity of abemaciclib monotherapy in pts with heavily pretreated poor prognosis mCRPC who progressed after both a novel hormonal agent (NHA) and two taxanes.

Methods: Eligible pts had progressive mCRPC, measurable disease by RECIST1.1, and previously received ≥1 NHA, docetaxel, and cabazitaxel for metastatic PC. Abemaciclib was administered at 200 mg BID on a continuous 28-day dosing schedule. The primary endpoint was investigator-assessed objective response rate without concurrent bone progression (ORR). A target ORR of ≥12.5% was deemed suitable to support further evaluation of abemaciclib monotherapy in this refractory mCRPC setting. Key secondary endpoints included disease control rate (DCR), time to PSA progression, radiographic progression-free survival (rPFS), overall survival (OS), and safety.

Results: Forty-four pts (median age 68 yrs; 75% ECOG PS 1, median PSA of 96 ng/mL) were enrolled. In total, 46.5% had visceral metastasis, including 27.9% with liver metastases. Median time from development of mCRPC to study entry was 2.1 yrs and the median number of prior systemic regimens for mCRPC was 3. Median number of treatment cycles was 3 (1-13). Five pts (11.8%) had soft tissue response. The ORR without concurrent bone progression was 6.8%. Eighteen pts (40.9%) had stable disease, of which 6 (13.6%) lasted ≥6 months (mos); DCR was 47.7%. Median rPFS was 2.7 mos (95% CI 1.9, 3.7); 6-mos rPFS rate was 24.9% (95% CI 12.4, 39.5); median time to PSA progression was 6.5 mos. Median OS was 7.6 mos (95% CI 5.6, NE). Any grade (G) TRAEs experienced by ≥50% of pts were diarrhea (79.5%), decreased appetite (52.3%) and fatigue (50%); majority were G1/2. G3 TRAEs in ≥ 5% of pts were neutropenia (22.7%), anemia (6.8%), fatigue (6.8%) and diarrhea (6.8%). There were no G4 or G5 TRAEs. Discontinuation rate due to AE was 13.6%.

Conclusions: Abemaciclib demonstrated modest but objective single-agent clinical activity in pts with very heavily pretreated progressive mCRPC. The safety profile of abemaciclib was consistent with the experience in breast cancer. Although the primary endpoint was not formally met, the single agent activity observed in this late line mCRPC setting validates CDK4/6 as a therapeutic target in advanced PC. The CYCLONE 2 and CYCLONE 3 studies are currently evaluating abemaciclib in combination with abiraterone/prednisone to leverage synergy of combined CDK4/6 and hormonal inhibition in first line mCRPC and mHSPC settings, respectively.

Citation Format: Neeraj Agarwal, Daniel Castellano Guana, Teresa A. Gordoa, Jose A. Arija, Emeline Colomba, Gwenaelle Gravis, Loic Mourey, Stephanie Oudard, Aude Flechon, Macarena Gonzalez, Pablo Maroto-Rey, Michael Schweizer, Enrique Gallardo, Karim Nacerddine, Adams K. Appiach, Arjun Balar, Erica Johnston, José M. Piulats. CYCLONE 1: abemaciclib in men with heavily pretreated metastatic castration-resistant prostate cancer (mCRPC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr CT159.