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INTEGRATE IIa Phase III Study: Regorafenib for Refractory Advanced Gastric Cancer
Nick Pavlakis1,2, Kohei Shitara3, Katrin Sjoquist4,5
1Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia.
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 v 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; P = .001; 361 events). INTEGRATE IIa alone OS HR was 0.68 (95% CI, 0.52 to 0.90; P = .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]; P < .0001) and delayed deterioration in global QoL (HR, 0.68 [95% CI, 0.52 to 0.89]; P = .0043). The toxicity profile was consistent with that of previous reports.
Conclusion:
Regorafenib improves survival compared with placebo in refractory AGOC.
Insights
Regorafenib significantly improves overall survival for patients with advanced gastric and esophagogastric junction cancer (AGOC) refractory to prior treatments. This oral multikinase inhibitor offers a new therapeutic option, enhancing progression-free survival and quality of life.
Area of Science:
- Oncology
- Gastroenterology
- Clinical Trials
Background:
- Advanced gastric and esophagogastric junction cancer (AGOC) presents limited treatment options for refractory cases.
- Regorafenib, an oral multikinase inhibitor, previously demonstrated improved progression-free survival (PFS) in the INTEGRATE I trial.
Purpose of the Study:
- To evaluate the efficacy of regorafenib in improving overall survival (OS) in patients with refractory advanced gastric and esophagogastric junction cancer (AGOC).
Main Methods:
- A double-blind, placebo-controlled, randomized phase III trial (INTEGRATE IIa) compared regorafenib plus best supportive care (BSC) against placebo plus BSC.
- Participants had confirmed metastatic/advanced AGOC with at least two prior therapies.
- The primary endpoint was overall survival (OS), with secondary endpoints including PFS, objective response rate, safety, and quality of life (QoL).
Main Results:
- Regorafenib demonstrated a significant improvement in pooled overall survival (OS) (HR 0.70; P = .001) and in the INTEGRATE IIa cohort alone (HR 0.68; P = .006).
- Median OS was 4.5 months with regorafenib versus 4.0 months with placebo.
- Regorafenib also significantly improved progression-free survival (PFS) (HR 0.53; P < .0001) and delayed QoL deterioration.
Conclusions:
- Regorafenib offers a survival benefit compared to placebo for patients with refractory advanced gastric and esophagogastric junction cancer (AGOC).
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