tbuckley/cabot-search huggingface dataset:
Phase II trial of sintilimab in cancer of unknown primary.
Authors: Ryan W Huey, Kanwal Pratap Singh Raghav, Jeannelyn Estrella, Victoria Higbie, Phat Le, Alisha Heather Bent, Aurelio Matamoros, Elizabeth A Lano, Anneleis Willett, Vincent Nguyen, Michelle Escano, Kaye F Wilson, Heather Y. Lin
Journal: Journal of Clinical Oncology (2025)

825 Background: CUP is an aggressive rare malignancy accounting for 2-4% of all cancers. Beyond frontline therapy, predominantly systemic cytotoxic chemotherapy, no clear standard of care exists. Preliminary data suggests that immune-checkpoint inhibitors have encouraging activity in patients with CUP. Prior anti-PD1 agents have demonstrated response rates of 21-23%. We studied the role of sintilimab, an anti-PD1 antibody, in CUP. Methods: In this phase II study (NCT05024968)10 patients (of planned 40) were enrolled prior to closure of the study due to sponsor funding. Patients were eligible if they were refractory or intolerant to one line of systemic therapy or had a contraindication for cytotoxic chemotherapy. Patients received sintilimab 200 mg IV every 3 weeks. Paired tumor biopsies were collected for biomarker analysis. The primary endpoint was confirmed objective response rate (cORR) by RECISTv1.1 assessed by independent radiology review. Key secondary endpoints were safety, disease control rate (DCR), duration of response (DOR), progression-free survival (PFS), overall survival (OS), and Quality of Life (QOL). Median PFS and OS were calculated according to the Kaplan-Meier method. Adverse events (AEs) were assessed according to CTCAE v5.0. Results: Between 10/2021 and 2/2023, 10 patients were enrolled and treated. Median age was 65 years and 30% of patients were female. Seven (70%) had poorly differentiated carcinoma. Patients received a median of 1 line of therapy prior to enrollment. Median follow-up was 19.8 months. All patients were evaluable for toxicity and response. The cORR was 40% (95% CI, 12.2 to 73.8); one (10%) patient with a complete response and 3 (30%) with partial responses. The median DOR was 15.7 months. Three patients (30%) had Grade ≥ 3 (no grade 4/5) treatment-related AEs including 2 patients with sepsis and 1 patient with leukocytosis. Median PFS and OS were 4.4 months (95% CI, 2.0 to 25.4) and 25.4 months (95% CI, 4.0 to 27.4), respectively. Conclusions: Anti-PD1 therapy with Sintilimab demonstrated significant anti-tumor activity for select patients with refractory CUP with safety profile consistent with other anti-PD1 agents. Ongoing correlative studies may inform the role of biomarker selection for immunotherapy in CUP. Clinical trial information: NCT05024968 .
Impact of time to surgery on outcomes in patients with advanced esophageal squamous cell carcinoma following neoadjuvant therapy: An exploratory analysis of phase III trial JCOG1109.
Authors: Ryosuke Kita, Ken Kato, Ryunosuke Machida, Yoshinori Ito, Hiroyuki Daiko, Hirofumi Kawakubo, Keita Sasaki, Haruhiko Fukuda, Yasue Kimura, Kohei Akiyoshi, Kazuo Koyanagi, Hiroki Hara, Keiko Minashi, Kenji Amagai, Tetsuya Abe, Hiroya Takeuchi
Journal: Journal of Clinical Oncology (2025)

458 Background: JCOG1109, a multicenter three-arm phase III trial, evaluated three neoadjuvant treatment regimens for advanced esophageal squamous cell carcinoma (ESCC), cisplatin and 5-fluorouracil (CF), docetaxel, cisplatin, and 5-fluorouracil (DCF), and cisplatin, 5-fluorouracil, and radiation therapy (CF-RT). The trial demonstrated the superiority of neoadjuvant DCF therapy in improving overall survival (OS). This exploratory analysis investigates the impact of the interval time from completion of neoadjuvant therapy to surgery (time to surgery, TTS) on both short- and long-term outcomes across different neoadjuvant therapy regimens. Methods: This analysis included patients from JCOG1109 who underwent surgery after neoadjuvant therapy. Patients were categorized into four TTS subgroups within each arm, based on quartiles of the overall cohort. Short-term outcomes such as perioperative complications, as well as long-term outcomes including OS and progression-free survival (PFS) were evaluated across these TTS subgroups. Results: Of the 601 patients enrolled in JCOG1109, 546 patients proceeded to surgery following neoadjuvant therapy. The median TTS was 35 days (range: 16-81) for the CF arm, 38 days (range: 17-109) for the DCF arm, and 41 days (range: 14-98) for the CF-RT arm. Baseline characteristics were well-balanced across all TTS subgroups in each treatment arm. Short-term outcomes revealed that operative time and overall proportions of postoperative complications were comparable. However, in the CF-RT arm, a longer TTS was associated with increased blood loss (200 ml, 210 ml, 300 ml, 370 ml; p-value for trend test = 0.010) and tended to increase the risk of anastomotic leakage (6%, 7%, 14%, 18%; p-value for trend test = 0.073). No significant differences in OS or PFS were observed across TTS subgroups in any treatment arm, with hazard ratios indicating no clear trend toward improved or worsened long-term outcomes. Conclusions: The timing of surgery following neoadjuvant therapy does not appear to affect long-term prognosis in patients with advanced ESCC, irrespective of the neoadjuvant therapy regimen. However, for patients undergoing neoadjuvant CF-RT, earlier surgery may be advantageous in reducing the risk of increased surgical complexity and anastomotic leakage.
Retrospective study evaluating the genomic landscape of anal squamous cell carcinoma using liquid biopsy.
Authors: Madison Conces, Sheila R. Solomon, J. Eva Selfridge, Melissa Amy Lumish, David L. Bajor, Sakti Chakrabarti, AMR Mohamed, Amit Mahipal
Journal: Journal of Clinical Oncology (2025)

8 Background: Advanced-stage squamous cell carcinoma of the anus (aSCCA) is a rare malignancy. Diagnostic biopsies are often inadequate for tissue-based genomic profiling, thus genomic profiles are largely unexplored in this setting. We assessed liquid biopsy NGS results of aSCCA patients (pts) and described genomic profiles by age and sex. To our knowledge, we are the first to describe genetic alterations by liquid biopsy in this patient population. Methods: Pts with aSCCA who underwent circulating tumor DNA (ctDNA) NGS with Guardant360 assays from 2017 to 2024 were included. Frequency of alterations were assessed based on sex and age (18-49 years (yrs), ≥50 yrs). Co-occurrence patterns were assessed using cBioPortal. Demographics were extracted from test requisition forms. Statistical analyses via two sided t-tests were performed with significance defined as p&lt;0.05. Results: 646 pts with aSCCA had non-synonymous ctDNA alterations detected; 69.2% (N=447) were female and 30.8% (N=199) male. Median age was 66 yrs (32-94) with 9.9% (N=64) &lt;50 yrs and 90.1% (N=582) ≥50 yrs. Most frequently altered genes were PIK3CA (17.3%), TP53 (9.8%), ATM (7.8%), EGFR (4.3%), and BRCA2 (4.2%). More unique genes were altered in ≥50 yrs cohort [53 mutations, 38 genes with copy number amplification (CNA)] vs &lt;50 yrs cohort (30 mutations, 66 CNA). Most frequent genes altered in &lt;50 yrs cohort were TP53 (17.6%), PIK3CA (13.2%), EGFR (11.0%), APC (4.4%), and MET (4.4%). PIK3CA (16.7%), TP53 (12.2%), ATM (8.8%), BRCA2 (5.5%), and EGFR (3.4%) were most frequent in ≥50 yrs cohort. More genes were altered in females (64 mutations, 32 CNA) vs. males (56 mutations, 41 CNA). Most frequent alterations in females were PIK3CA E545K (3.4%), PIK3CA CNA (2.8%), PIK3CA E542K (1.9%), and ATM CNA (1.0%) vs in male pts being PIK3CA E545K (4.8%), PIK3CA CNA (3.3%), PIK3CA E542K (3.3%), EGFR CNA (1.6%), TERT promoter (1.0%). Overall, PIK3CA and TP53 alterations were mutually exclusive (odds ratio 0.43, p&lt;0.001). Conclusions: Liquid biopsy is feasible in patients with aSCCA. Most frequently detected alterations and CNAs were in PIK3CA and TP53 in aSCCA which is consistent with prior studies evaluating aSCCA tumor NGS in tissue-based assays. Alterations varied across age and sex. PIK3CA E545K and E542K alterations were detected frequently in this population and have on-label therapies for non-aSCCA indications which may be a source for clinical consideration in this cancer type in the future. This data illustrates the importance of liquid biopsy NGS to also screen for clinical trial enrollment in a disease which is poorly responsive to standard therapy. Additional research is warranted to further elucidate genomic profiles for clinical applications of this rare tumor.
Preliminary result of a phase Ib study: Efficacy and safety of FG-M108 plus gemcitabine/nab-paclitaxel as first-line (1L) treatment in patients with Claudin18.2-positive locally advanced unresectable or metastatic (LA/m) pancreatic cancer.
Authors: Funan Liu, Yanqiao Zhang, Shu Zhang, Jifang Gong, Miao Zhang, Xinjun Liang, Junye Wang, Yun Li, Zhaoyu Jin, Yaping Yang, Guoliang Ding, Chen Tian, Lin Shen
Journal: Journal of Clinical Oncology (2025)

729 Background: FG-M108, an ADCC-enhanced anti-CLDN18.2 monoclonal antibody, showed significant efficacy in 1L treatment of gastric cancer. Herein, we report the safety and efficacy results of FG-M108 in 1L treatment of pancreatic cancer (cohort C2&amp;D2). Methods: In this open-label, multicenter phase I/II study patients received FG-M108 (cohort C2: 300mg/m 2 or cohort D2: 600mg/m 2 Q3W) plus gemcitabine (1000mg/m 2 , d1, d8, Q3W) and nab-paclitaxel (125mg/m 2 , d1, d8, Q3W). Eligible patients were those with CLDN18.2 positive (IHC 1+/2+/3+≥10%) previously untreated LA/m pancreatic cancer. The primary endpoint were the incidence of adverse events (AEs) and preliminary clinical efficacy (ORR, DCR, DOR, PFS, and OS). Results: As of Sep 5 2024, 50 patients were enrolled and received FG-M108+gemcitabine/nab-paclitaxel treatment (39 patients in cohort C2, 11 patients in cohort D2). The median age was 61 (range 30-72). 47 (94%) patients were with CLDN18.2 moderate-high expression (IHC 2+/3+≥40%). Out of 50 patients, 44 patients had at least one tumor assessment after baseline and included in the efficacy analysis set. The results of ORR and DCR in cohort C2 were 32.4% and 100.0%, while that in cohort D2 were 30.0% and 90.0%, respectively. In cohort C2, the median PFS and median DOR were 6.8 months and 9.8 months, respectively. In the subgroup patients with CLDN18.2 moderate-high expression, the median PFS and median DOR were 7.6 months and 9.8 months, respectively. The median OS has not been reached. FG-M108 related AEs were observed in all patients, with 39 patients (78%) having Grade 3/4 AEs and no FG-M108 related fatal AE was observed. The most common FG-M108 related AEs in cohort C2 &amp; D2 were anemia (56.2% vs 63.6%), nausea (56.4% vs 36.4%), vomiting (48.7% vs 45.5%), and hypoalbuminemia (46.2% vs 54.5%). Conclusions: The combined therapy of FG-M108 plus chemotherapy as 1L treatment for patients with CLDN18.2 positive pancreatic cancer was well tolerated with encouraging survival especially in patients with CLDN18.2 moderate-high expression, deserving further investigation. Clinical trial information: NCT04894825 .
HERIZON-BTC-302: A phase 3 study of zanidatamab with standard-of-care (SOC) therapy vs SOC alone for first-line treatment of human epidermal growth factor receptor 2 (HER2)-positive advanced/metastatic biliary tract cancer (BTC).
Authors: James J. Harding, Teresa Macarulla, Shubham Pant, Xiaotian Wu, Phillip M. Garfin, Takuji Okusaka
Journal: Journal of Clinical Oncology (2025)

TPS648 Background: Zanidatamab is a humanized, IgG1-like, HER2-targeted bispecific antibody that simultaneously binds to 2 non-overlapping domains on HER2. Zanidatamab is being investigated for the treatment of HER2-expressing solid tumors, including BTC. In the phase 2 HERIZON-BTC-01 trial, zanidatamab monotherapy demonstrated promising antitumor activity in 80 patients with previously treated HER2-positive BTC. Confirmed objective response rate (cORR) was 41.3% with rapid and durable responses and a manageable safety profile. This phase 3 trial is assessing zanidatamab + SOC therapy vs SOC alone for first-line treatment of HER2-positive advanced/metastatic BTC. Methods: This ongoing, global, phase 3, randomized, open-label trial (NCT06282575) is investigating the efficacy and safety of zanidatamab with cisplatin and gemcitabine (CisGem) vs CisGem alone ± a programmed cell death protein-1/ligand 1 (PD-1/L1) inhibitor (pembrolizumab or durvalumab at physician’s discretion if locally approved) as first-line treatment for patients with advanced HER2-positive BTC. Eligibility criteria include ≥18 years of age; locally advanced, unresectable, or metastatic HER2-positive BTC by immunohistochemistry and in situ hybridization assay (IHC 3+ or IHC 2+/ISH+); and Eastern Cooperative Oncology Group performance status ≤1. Patients may have received ≤2 cycles of a gemcitabine-based regimen ± pembrolizumab or durvalumab. Prior HER2-targeted therapy is not allowed except for patients who completed it for breast cancer &gt;5 years prior to BTC diagnosis. Eligible patients will be randomized to receive zanidatamab (flat 2-tiered dosing: 1800 mg intravenous [IV; body weight &lt;70 kg] or 2400 mg IV [body weight ≥70 kg] every 3 weeks) + a standard dose of CisGem ± a PD1/L1 inhibitor or CisGem alone ± a PD1/L1 inhibitor (≤8 cycles). The primary endpoint is progression-free survival (PFS) in patients with IHC 3+ tumors. Secondary/exploratory endpoints include overall survival (IHC 3+ subgroup; overall population), PFS (overall population), cORR, incidence and severity of adverse events, and patient-reported outcomes. The study is currently recruiting patients. Clinical trial information: NCT06282575 .
Comparison of mutational landscape in primary and metastatic pancreatic tumors.
Authors: Jean-Paul De La O, Jess R Hoag, Gargi D. Basu, Arthur Starodynov, Angela Deem, Madappa N. Kundranda
Journal: Journal of Clinical Oncology (2025)

781 Background: Genomic profiling has brought to the forefront the clinical relevance of intratumoral heterogeneity. Oncogenic KRAS mutation is the most common driver event in pancreatic ductal adenocarcinoma (PDAC), but little is known about how KRAS alteration may cooperate with other genetic lesions to support dissemination and growth of metastatic disease. Therefore, an improved understanding of molecular events affecting the clinical course of KRAS -altered PDAC is needed to identify biomarkers of early disease and expand the repertoire of targeted therapies. Methods: We retrospectively analyzed tissue samples from PDAC patients using the OncoExTra tumor-normal whole exome and whole transcriptome test between April 2018 and May 2024. The prevalence of actionable somatic alterations was determined overall and by specimen location (primary vs. metastatic). Fisher’s exact test with FDR-based correction for multiple testing was used to identify co-alterations with KRAS and 19 DNA damage response (DDR) gene alterations. Results: PDAC samples from 434 patients (51.2% female; mean age 65.4±10.9 years) were analyzed. KRAS alterations were detected in 369 (85.0%) samples: 198 (45.6%) primary and 239 (55.1%) metastatic. KRAS G12D (32.7%) and KRAS G12V (29.5%) were the most common KRAS mutations. The frequency of KRAS alterations was 85.9% and 84.5% in primary and metastatic samples, respectively. TP53 alterations occurred in 68.2% samples overall and in 64.6% and 71.1% of primary and metastatic samples, respectively. Examination of co-alterations in KRAS -altered versus KRAS -WT samples uncovered enrichment of TP53 alterations in KRAS -altered (277 samples, 75.1%) compared to KRAS -WT samples (19 samples, 29.2%) ( p &lt;0.001). Also, BRAF mutations and SND1:BRAF fusions exclusively occurred in metastatic KRAS -WT samples, although the number of events was small ( n =4 and n =2, respectively). We also found that MTAP was significantly co-altered in metastatic KRAS -WT samples (n=6, 16.2%) compared to KRAS -altered samples (6 samples, 3.0%) ( p =0.004). A total of 21.9% of all PDAC samples had an alteration in at least 1 DDR gene. No associations were observed between KRAS alteration status and alteration in DDR genes. However, TP53 alterations were more frequent in non-DDR-altered samples ( p &lt;0.001), while CDKN2B alterations were enriched in DDR-altered samples ( p =0.025). Conclusions: We observed expected rates of alterations in known PDAC driver genes and uncovered higher co-occurrence of KRAS and TP53 alteration in metastatic samples. Additionally, TP53 alterations were less frequent in DDR-altered samples. Our findings suggest that a number of therapy approaches including BRAF, WEE1, PARP, and KRAS inhibitors as well as epigenetic modulators, alone or in combination, could improve clinical outcomes in PDACs with specific mutational profiles.
Risk of second primary cancer among patients with a first primary appendiceal adenocarcinoma.
Authors: Andreana Natalie Holowatyj, Richard M Goldberg, Mary Kay Washington, Caitlin C. Murphy
Journal: Journal of Clinical Oncology (2025)

819 Background: Incidence rates of rare appendiceal cancers are increasing across the United States. Although this is suggestive of a growing population of appendiceal cancer survivors over time, the risk of second primary cancers specific to patients with a first primary appendiceal adenocarcinoma remains unknown. Methods: We conducted a population-based study of adults (age ≥18 years) diagnosed with a first primary appendiceal adenocarcinoma from 1992 to 2021, using data from the Surveillance, Epidemiology, and End Results (SEER) Program. We estimated cumulative incidence of second primary cancer, defined as any primary cancer diagnosed at least 3 months after appendiceal adenocarcinoma, with Fine and Gray methods to account for the competing risk of death. For comparison to the general population, we also estimated standardized incidence ratios [SIRs], or the observed number of second cancers relative to the expected number based on age-, sex-, and race-specific incidence rates. Results: A total of 5,827 adults diagnosed with a first primary appendiceal adenocarcinoma (mean age 58.0 years; 51.8% female; 68.5% non-Hispanic White) were identified during the study period, of whom 418 developed a second primary cancer. The most common types of second primary cancer were prostate (17.7%), colorectal (14.4%), female breast (10.5%), lung (8.4%), and melanoma (6.0%). At 10 and 20 years after appendiceal adenocarcinoma diagnosis, the cumulative incidence of second primary cancer was 7.5% (95%CI 6.8%-8.4%) and 11.7% (95%CI 10.5%-12.9%), respectively. Cumulative incidence significantly differed by sex (p&lt;0.01) and age at appendiceal adenocarcinoma diagnosis (early-onset [age&lt;50] vs late-onset; p&lt;0.01). For example, at 10 years post-diagnosis, the cumulative incidence of second primary cancer was 6.4% (95%CI 5.4%-7.4%) for females and 8.8% (95%CI 7.6%-10.1%) for males. The overall SIR for any second primary cancer was 1.12 (95%CI, 1.02-1.23)—corresponding to 14.8 excess cancers per 10,000 person-years. SIRs for common types of second primary cancers were: 1.07 (95%CI 0.84-1.35) for prostate, 2.12 (95%CI 1.63-2.70) for colorectal, 0.91 (95%CI 0.68-1.19) for female breast, 0.81 (95%CI 0.58-1.09) for lung, and 1.20 (95%CI 0.79-1.73) for melanoma. Conclusions: Approximately one in every 13 adults diagnosed with a first primary appendiceal adenocarcinoma in the United States will be diagnosed with a second primary cancer within 10 years. After diagnosis of an appendiceal adenocarcinoma, patients have a 12% excess incidence in second primary cancers and double the excess incidence in second primary colorectal cancers compared to the general population. Implementation of cancer prevention and early detection strategies (e.g., colonoscopy screening, genetic testing) for patients with an appendiceal adenocarcinoma is a clinical priority.
MEK inhibitor-based therapy in metastatic pancreatic adenocarcinoma with <i>KRAS</i> G12R alteration.
Authors: Elizabeth Auckley, Grace Ying, Stephanie Yohay, Mohammed Aldakkak, Samih Z Thalji, Parnian Vakili, Justin Grahl, Bradley Mayer, Faisal Shahjehan, Soon Khai Low, Douglas B. Evans, Kathleen K. Christians, Yongwoo David Seo, Beth Erickson, William Adrian Hall, Thomas McFall, Razelle Kurzrock, Ben George, Mandana Kamgar
Journal: Journal of Clinical Oncology (2025)

725 Background: Pancreatic ductal adenocarcinoma (PDAC) is largely driven by oncogenic alterations in the KRAS , TP53 , CDKN2A/B , and SMAD4 genes. KRAS G12R accounts for nearly 20% of KRAS alterations in PDAC, is biologically unique, and offers the potential for improved response to MEK inhibitor (MEK-inh)-based therapy. As part of the MCW-Master-PREDICT (NCT05802069) observational study, we evaluated the efficacy of MEK-inh-based therapy matched to the unique molecular alterations in the tumor of each patient as recommended by the molecular tumor board. Methods: From March 2022 to December 2023, 8 patients with metastatic PDAC were treated with MEK-inh-based therapy. Molecular profiling was performed by Tempus (648 genes) in 7 patients, and FoundationOne (324 genes) in 1 patient. Description of molecular alterations, matched therapies, and efficacy of treatment are provided. Results: The median age of patients starting MEK inhibitor-based therapy was 69 years, with 62% of them being female. The molecular characteristics and matched therapies are summarized (Table). MEK-inh-based therapy was administered to 3 (37.5%) patients as a first or second-line treatment, and to 5 (62.5%) patients as a third to fifth-line treatment for metastatic PDAC. The overall survival and progression free survival (PFS) on MEK-inh-based therapy was 8.4 and 4.9 months, respectively. Four patients had PFS beyond 4 months (4.9, 5.5, 5.6 and 6.9 months). Conclusions: Individualized MEK-inh-based therapy demonstrated efficacy in late-line treatment of metastatic PDAC with KRAS G12R alterations. Using this approach earlier in the treatment course and in combination with RAS inhibitors or cytotoxic systemic therapies may further enhance outcomes. Tumor alterations and matched therapies. Gene altered Number of patients (%) Number of patients matched (%) Drug family matched KRAS G12R 8 (100) 8/8 (100) MEK inhibitor TP53 7 (87.5) 4/7 (57) VEGF/VEGR inhibitor* CDKN2A 4 (50) 4/4 (100) CDK4/6 inhibitor** SMAD4 2 (25) 2/2 (100) MEK inhibitor + (EGFR or Pan-HER inhibitor)*** *PMID: 27466356; **PMID: 33472910; ***PMID: 36127339, PMID: 24625091.