TY - JOUR
T1 - Ripretinib versus sunitinib in gastrointestinal stromal tumor
T2 - ctDNA biomarker analysis of the phase 3 INTRIGUE trial
AU - Heinrich, Michael C.
AU - Jones, Robin L.
AU - George, Suzanne
AU - Gelderblom, Hans
AU - Schöffski, Patrick
AU - von Mehren, Margaret
AU - Zalcberg, John R.
AU - Kang, Yoon Koo
AU - Razak, Albiruni Abdul
AU - Trent, Jonathan
AU - Attia, Steven
AU - Le Cesne, Axel
AU - Siontis, Brittany L.
AU - Goldstein, David
AU - Boye, Kjetil
AU - Sanchez, Cesar
AU - Steeghs, Neeltje
AU - Rutkowski, Piotr
AU - Druta, Mihaela
AU - Serrano, César
AU - Somaiah, Neeta
AU - Chi, Ping
AU - Reichmann, William
AU - Sprott, Kam
AU - Achour, Haroun
AU - Sherman, Matthew L.
AU - Ruiz-Soto, Rodrigo
AU - Blay, Jean Yves
AU - Bauer, Sebastian
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/2/1
Y1 - 2024/2/1
N2 - INTRIGUE was an open-label, phase 3 study in adult patients with advanced gastrointestinal stromal tumor who had disease progression on or intolerance to imatinib and who were randomized to once-daily ripretinib 150 mg or sunitinib 50 mg. In the primary analysis, progression-free survival (PFS) with ripretinib was not superior to sunitinib. In clinical and nonclinical studies, ripretinib and sunitinib have demonstrated differential activity based on the exon location of KIT mutations. Therefore, we hypothesized that mutational analysis using circulating tumor DNA (ctDNA) might provide further insight. In this exploratory analysis (N = 362), baseline peripheral whole blood was analyzed by a 74-gene ctDNA next-generation sequencing–based assay. ctDNA was detected in 280/362 (77%) samples with KIT mutations in 213/362 patients (59%). Imatinib-resistant mutations were found in the KIT ATP-binding pocket (exons 13/14) and activation loop (exons 17/18). Mutational subgroup assessment showed 2 mutually exclusive populations with differential treatment effects. Patients with only KIT exon 11 + 13/14 mutations (ripretinib, n = 21; sunitinib, n = 20) had better PFS with sunitinib versus ripretinib (median, 15.0 versus 4.0 months). Patients with only KIT exon 11 + 17/18 mutations (ripretinib, n = 27; sunitinib, n = 25) had better PFS with ripretinib versus sunitinib (median, 14.2 versus 1.5 months). The results of this exploratory analysis suggest ctDNA sequencing may improve the prediction of the efficacy of single-drug therapies and support further evaluation of ripretinib in patients with KIT exon 11 + 17/18 mutations. ClinicalTrials.gov identifier: NCT03673501.
AB - INTRIGUE was an open-label, phase 3 study in adult patients with advanced gastrointestinal stromal tumor who had disease progression on or intolerance to imatinib and who were randomized to once-daily ripretinib 150 mg or sunitinib 50 mg. In the primary analysis, progression-free survival (PFS) with ripretinib was not superior to sunitinib. In clinical and nonclinical studies, ripretinib and sunitinib have demonstrated differential activity based on the exon location of KIT mutations. Therefore, we hypothesized that mutational analysis using circulating tumor DNA (ctDNA) might provide further insight. In this exploratory analysis (N = 362), baseline peripheral whole blood was analyzed by a 74-gene ctDNA next-generation sequencing–based assay. ctDNA was detected in 280/362 (77%) samples with KIT mutations in 213/362 patients (59%). Imatinib-resistant mutations were found in the KIT ATP-binding pocket (exons 13/14) and activation loop (exons 17/18). Mutational subgroup assessment showed 2 mutually exclusive populations with differential treatment effects. Patients with only KIT exon 11 + 13/14 mutations (ripretinib, n = 21; sunitinib, n = 20) had better PFS with sunitinib versus ripretinib (median, 15.0 versus 4.0 months). Patients with only KIT exon 11 + 17/18 mutations (ripretinib, n = 27; sunitinib, n = 25) had better PFS with ripretinib versus sunitinib (median, 14.2 versus 1.5 months). The results of this exploratory analysis suggest ctDNA sequencing may improve the prediction of the efficacy of single-drug therapies and support further evaluation of ripretinib in patients with KIT exon 11 + 17/18 mutations. ClinicalTrials.gov identifier: NCT03673501.
UR - http://www.scopus.com/inward/record.url?scp=85181488131&partnerID=8YFLogxK
U2 - 10.1038/s41591-023-02734-5
DO - 10.1038/s41591-023-02734-5
M3 - Article
AN - SCOPUS:85181488131
SN - 1078-8956
VL - 30
SP - 498
EP - 506
JO - Nature Medicine
JF - Nature Medicine
IS - 2
ER -