Abstract PD18-10: Treatment of HER2-positive (HER2+) hormone-receptor positive (HR+) metastatic breast cancer (mBC) with the novel combination of zanidatamab, palbociclib, and fulvestrant
Authors: Escrivá-de-Romani Santiago , Alba Emilio , Rodríguez-Lescure Álvaro , Hurvitz Sara , Cejalvo Juan Miguel , Gión Maria , Ferrario Cristiano , Borrego Manuel Ruiz , Pezo Rossanna C. , Hamilton Erika , Webster Marc , Pluard Timothy , Beeram Muralidhar , Rodríguez Begoña Jiménez , Linden Hannah , Saura Cristina , Omidpanah Adam , Harvey Phoebe , Savard Marie-France 
Published: March 2023

Abstract
Background: HER2+ mBC remains incurable, with a need for new HER2-directed therapies and regimens, including chemotherapy-free options. Zanidatamab (zani) is a novel HER2-targeted bispecific antibody that binds HER2 in a unique trans configuration, driving multiple mechanisms of antitumor activity, including complement-dependent cytotoxicity. A CDK4/6 inhibitor combined with endocrine therapy is an approved treatment for HER2-negative/HR+ mBC and this combination has also demonstrated encouraging antitumor activity when paired with HER2-targeted therapy(ies) in HER2+/HR+ mBC. Here, we report results from ZWI-ZW25-202 (NCT04224272), an ongoing single-arm phase 2 study of zani combined with palbociclib (palbo) and fulvestrant (fulv) in pts with HER2+/HR+ mBC. Methods: Eligibility requirements include: HER2+/HR+ unresectable, locally advanced BC or mBC; ECOG PS of 0 or 1; prior treatment with trastuzumab, pertuzumab and T DM1 (additional prior HER2-targeting agents are permitted); and no prior treatment with CDK4/6 inhibitors. Part 1 of the study evaluated the safety and tolerability of the zani/palbo/fulv combination and determined the recommended doses for use in Part 2, where the antitumor activity of the combination is being evaluated. Endpoints include safety outcomes, progression-free survival at 6 months (PFS6), confirmed objective response rate (cORR) per RECIST v1.1; disease control rate (DCR=complete response [CR] plus partial response [PR] plus stable disease [SD]); duration of response (DOR); PFS; and overall survival. Results: As of 24 Feb 2022, 34 pts (33 HER2+/HR+ per central analysis) with a median age of 52 (range 36-77) have been treated. In the metastatic setting, pts had received a median (range) of 4 (1-10) prior systemic regimens, including 3 (1-8) different prior HER2 targeted therapies, and 1 (0-4) endocrine therapy. Seven pts (20%) had prior T DXd treatment and 7 pts had prior fulv treatment. All pts received zani (20 mg/kg Q2W) and standard doses of palbo and fulv. Eighteen pts (53%) remained on treatment; median duration of zani treatment was 6.9 mo (range 0.5-16.3). A dose-limiting toxicity (DLT) of neutropenia occurred in 1 of 7 DLT-evaluable pts in Part 1. Among all pts (n=34), the most common (&gt;20%) treatment (zani, palbo and/or fulv)-related adverse events (TRAEs) were diarrhea (74%), neutrophil count decreased/neutropenia (62%), stomatitis (41%), asthenia (26%), nausea (24%), and anemia (21%). Grade (Gr) ≥3 TRAEs in 2 or more pts included neutrophil count decreased/neutropenia (50%), anemia (6%), diarrhea (6%), and thrombocytopenia (6%). AEs of special interest were all Gr ≤2 and included 4 pts with cardiac events (LVEF decrease of ≥10% from baseline) and 1 pt with infusion-related reaction. There were no treatment-related serious AEs. Palbo was discontinued for 1 pt due to an AE (AST increase); no pt discontinued zani treatment as a result of AEs. Two deaths occurred: 1 due to disease progression and 1 due to an unrelated AE of pneumonia caused by COVID-19. In 29 pts with measurable disease, the cORR was 34.5% (95% CI: 17.9, 54.3), all responses were cPRs, of which 1 is pending CR confirmation. DOR ranged from 2.3 to 14.9+ mo, with 8 confirmed responses ongoing, and the DCR was 93.1% (95% CI: 77.2, 99.2). Interim median PFS was 11.3 mo (range 0.03-16.7; 95% CI: 5.6, not estimable). PFS6 analysis is planned following the completion of enrollment. Conclusions: Zani in combination with palbo and fulv shows encouraging antitumor activity with durable responses in heavily pretreated pts and a manageable safety profile. This regimen has the potential to be a chemotherapy-free treatment option in pts with HER2+/HR+ mBC. Enrollment in the study is continuing.
Citation Format: Santiago Escrivá-de-Romani, Emilio Alba, Álvaro Rodríguez-Lescure, Sara Hurvitz, Juan Miguel Cejalvo, Maria Gión, Cristiano Ferrario, Manuel Ruiz Borrego, Rossanna C. Pezo, Erika Hamilton, Marc Webster, Timothy Pluard, Muralidhar Beeram, Begoña Jiménez Rodríguez, Hannah Linden, Cristina Saura, Adam Omidpanah, Phoebe Harvey, Marie-France Savard. Treatment of HER2-positive (HER2+) hormone-receptor positive (HR+) metastatic breast cancer (mBC) with the novel combination of zanidatamab, palbociclib, and fulvestrant [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD18-10.