Avelumab Plus Talazoparib in Patients With Advanced Solid Tumors: The JAVELIN PARP Medley Nonrandomized Controlled Trial.

Preclinical data suggest that poly(ADP-ribose) polymerase (PARP) inhibitors have synergistic activity when combined with immune checkpoint inhibitors (ICIs); however, it is unknown which tumor types or molecular subtypes may benefit from this combination.

To investigate responses associated with the combination of avelumab and talazoparib in different tumor types and/or molecular subtypes.

In this phase 1b and 2 basket nonrandomized controlled trial, patients with advanced solid tumors were enrolled in the following cohorts: non-small cell lung cancer (NSCLC); DNA damage response (DDR)-positive NSCLC; triple-negative breast cancer (TNBC); hormone receptor-positive, human epidermal growth factor receptor 2 (ERBB2)-negative, DDR-positive breast cancer; recurrent, platinum-sensitive ovarian cancer (OC); recurrent, platinum-sensitive, BRCA1/2-altered OC; urothelial cancer; metastatic castration-resistant prostate cancer (mCRPC); DDR-positive mCRPC; and BRCA1/2- or ATM-altered solid tumors. Data were analyzed between June 17, 2021, and August 6, 2021.

All patients in phases 1b and 2 received avelumab plus talazoparib.

The phase 1b primary end point was dose-limiting toxic effects. The phase 2 primary end point was objective response, measured as objective response rate (ORR). Secondary end points included safety, time to response, duration of response (DOR), progression-free survival, time to prostate-specific antigen progression and PSA response of 50% or greater (for mCRPC), cancer antigen 125 response (for OC), pharmacokinetics, immunogenicity, and biomarkers.

A total of 223 patients (mean [SD] age, 63.2 [11.0] years; 117 [52.5%] men) were treated, including 12 patients in phase 1b and 211 patients in phase 2. The recommended phase 2 dose was avelumab 800 mg every 2 weeks plus talazoparib 1 mg once daily. In phase 2, the ORR was 18.2% (95% CI, 5.2%-40.3%) in patients with TNBC; 34.8% (95% CI, 16.4%-57.3%) in patients with HR-positive, ERBB2-negative, and DDR-positive BC; and 63.6% (95% CI, 30.8%-89.1%) in patients with platinum-sensitive, BRCA1/2-altered OC. Responses occurred more frequently in patients with BRCA1/2-altered tumors. Durable responses were observed in patients with TNBC (median [range] DOR, 11.1 [3.4-20.4] months); HR-positive, ERBB2-negative, and DDR-positive BC (median [range] DOR, 15.7 [3.9 to ≥20.6] months); and BRCA1/2-altered OC (median DOR not reached; range, 5.6 to ≥18.4 months). The most common grade 3 or greater treatment-related adverse events were anemia (75 patients [33.6%]), thrombocytopenia (48 patients [21.5%]), and neutropenia (31 patients [13.9%]).

This nonrandomized controlled trial found that ORRs for avelumab plus talazoparib were comparable with those with PARP inhibitor or ICI monotherapy. Prolonged DOR in patients with TNBC; HR-positive, ERBB2-negative, and DDR-positive BC; and BRCA1/2-altered OC warrant further investigation in randomized clinical trials. These data highlight the importance of prospective patient selection in future studies of ICI and PARP-inhibitor combinations.

ClinicalTrials.gov Identifier: NCT03330405.

JAMA oncology. 2022 Nov 17 [Epub ahead of print]

Timothy A Yap, Aditya Bardia, Michael Dvorkin, Matthew D Galsky, J Thaddeus Beck, David R Wise, Oleg Karyakin, Gábor Rubovszky, Nikolay Kislov, Kristoffer Rohrberg, Anil Abraham Joy, Melinda L Telli, Alison M Schram, Umberto Conte, Colombe Chappey, Ross Stewart, Daria Stypinski, Elisabete Michelon, Rossano Cesari, Panagiotis A Konstantinopoulos

The University of Texas MD Anderson Cancer Center, Houston., Massachusetts General Hospital, Boston., Clinical Oncology Dispensary, Budget Healthcare Institution of Omsk Region, Omsk, Russian Federation., Icahn School of Medicine at Mount Sinai, New York, New York., Highlands Oncology Group, Springdale, Arkansas., NYU Laura and Isaac Perlmutter Cancer Center, New York, New York., Medical Radiological Research Center, Kaluga, Russian Federation., National Institute of Oncology, Budapest, Hungary., Yaroslavl Regional Cancer Hospital, Yaroslavl, Russian Federation., Department of Oncology, Phase I Unit, Rigshospitalet, Copenhagen, Denmark., Cross Cancer Institute, Department of Oncology, University of Alberta, Edmonton, Canada., Stanford University School of Medicine, Stanford, California., Memorial Sloan Kettering Cancer Center, New York, New York., Pfizer, New York, New York., Pfizer, San Francisco, California., Now with Translational Medicine, Oncology at AstraZeneca, Cambridge, United Kingdom., Pfizer, San Diego, California., Pfizer, Milan, Italy., Dana-Farber Cancer Institute, Boston, Massachusetts.

Read an Expert Commentary by Bishoy Faltas, MD