AI Article Synopsis
- Regorafenib, an oral multikinase inhibitor, was tested in the INTEGRATE IIa trial to see if it improves overall survival in patients with advanced gastric and esophagogastric junction cancer who did not respond to at least two prior treatments.
- The trial compared regorafenib plus supportive care against a placebo with supportive care, enrolling 251 participants and evaluating various outcomes like overall survival (OS), progression-free survival (PFS), and quality of life (QoL).
- Results showed that regorafenib significantly improved OS and PFS compared to placebo, with a median OS of 4.5 months for those receiving regorafenib versus 4.0 months for those on placebo, while also
Article Abstract
Purpose: Treatment options for refractory advanced gastric and esophagogastric junction cancer (AGOC) are limited. Regorafenib, an oral multikinase inhibitor, prolonged progression-free survival (PFS) versus placebo in the INTEGRATE I phase II trial. INTEGRATE IIa was designed to examine whether regorafenib improved overall survival (OS).
Methods: A double-blind placebo-controlled phase III trial compared regorafenib and best supportive care (BSC) versus placebo and BSC for participants with confirmed evaluable metastatic/advanced AGOC who failed ≥two prior therapies on a 2:1 random assignment, stratified by tumor location, geographic region (Asia rest of world), and prior vascular endothelial growth factor inhibitors. The primary end point was OS. Treatment efficacy on OS was first tested in the pooled INTEGRATE I + INTEGRATE IIa cohort and, if significant, then in the INTEGRATE IIa cohort. Secondary end points were PFS, objective response rate, safety, and quality of life (QoL).
Results: INTEGRATE IIa enrolled 251 participants: 157 from Asia and 94 from rest of world and 169 received regorafenib and 82 received placebo. No significant heterogeneity was observed between INTEGRATE I and INTEGRATE IIa studies on OS. Pooled OS analysis hazard ratio (HR) was 0.70 (95% CI, 0.56 to 0.87; = .001; 361 events). INTEGRATE IIa alone OS HR was 0.68 (95% CI, 0.52 to 0.90; = .006; 238 events), the median OS was 4.5 months versus 4.0 months, and 12-month survival rates were 19% and 6%, for regorafenib versus placebo, respectively. After a preplanned adjustment for multiplicity, there were no statistically significant differences across regions or other prespecified subgroups. Regorafenib improved PFS (HR, 0.53 [95% CI, 0.40 to 0.70]; < .0001) and delayed deterioration in global QoL (HR, 0.68 [95% CI, 0.52 to 0.89]; = .0043). The toxicity profile was consistent with that of previous reports.
Conclusion: Regorafenib improves survival compared with placebo in refractory AGOC.
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| http://dx.doi.org/10.1200/JCO.24.00055 | DOI Listing |
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