Everolimus for the treatment of advanced gastrointestinal or lung nonfunctional neuroendocrine tumors in East Asian patients: a subgroup analysis of the RADIANT-4 study
Received 1 August 2018
Accepted for publication 9 January 2019
Published 28 February 2019 Volume 2019:12 Pages 1717—1728
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Andrew Yee
Peer reviewer comments 2
Editor who approved publication: Dr William Cho
James C Yao,1 Do-Youn Oh,2 Jiaming Qian,3 Young Suk Park,4 Fabian Herbst,5 Antonia Ridolfi,6 Miguel Izquierdo,5 Tetsuhide Ito,7 Liqun Jia,8 Izumi Komoto,9 Virote Sriuranpong,10 Yasuhiro Shimada11
1Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; 2Department of Medical Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea; 3Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China; 4Department of Hematology and Oncology, Samsung Medical Center, Seoul, South Korea; 5Novartis Oncology, Novartis Pharma AG, Basel, Switzerland; 6Novartis Oncology, Novartis Pharma S.A.S, Rueil-Malmaison, Paris, France; 7Department of Gastroenterology, Kyushu University Hospital, Fukuoka, Japan; 8Department of Medical Oncology, China-Japan Friendship Hospital, Beijing, China; 9Department of Surgery, Kansai Electric Power Hospital, Osaka, Japan; 10Department of Medical Oncology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; 11Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, Japan
Background: In RADIANT-4, everolimus showed an improvement of 7.1 months in median progression-free survival (PFS) vs placebo among patients with advanced, well-differentiated, nonfunctional neuroendocrine tumors (NETs) of gastrointestinal (GI) or lung origin. The present analysis focuses on the effect of everolimus on the East Asian-subgroup population of the RADIANT-4 study.
Methods: Patients were randomized to receive everolimus 10 mg/day or matching placebo. The primary end point was PFS (central review). Secondary end points were overall response rate, safety, and tolerability.
Results: Among 302 patients enrolled in RADIANT-4, 46 were included in the East Asian subgroup (everolimus, n=28; placebo, n=18) analysis. Everolimus was associated with an 82% reduction in the relative risk of disease progression or death (HR 0.18, 95% CI 0.09–0.38). The median PFS (central review) in this subgroup was 11.2 months with everolimus vs 3.1 months with placebo. Adverse events (AEs) occurred in all 28 patients treated with everolimus and ten patients receiving placebo. The majority of these AEs were grade 1 or 2. Most commonly reported (≥30% of incidence) drug-related AEs of any grade included stomatitis (75%, n=21) and rash (43%, n=12) in the everolimus arm.
Conclusion: Everolimus demonstrated a clinically meaningful PFS benefit in the East Asian population. The safety findings were consistent with the known safety profile of everolimus. These results support the use of everolimus in the East Asian population with advanced, nonfunctional NETs of GI or lung origin.
Keywords: mTOR inhibitors, everolimus, RADIANT-4, neuroendocrine tumors, East Asian population
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