On March 21, 2023 Astellas Pharma Inc. (TSE: 4503, President and CEO: Kenji Yasukawa, Ph.D., "Astellas")reported that it will present detailed results from the Phase 3 GLOW trial evaluating first-line treatment with zolbetuximab, an investigational first-in-class Claudin 18.2 (CLDN18.2) targeted monoclonal antibody, plus CAPOX (a combination chemotherapy regimen that includes capecitabine and oxaliplatin) versus placebo plus CAPOX in patients with CLDN18.2-positive, HER2-negative, locally advanced unresectable or metastatic gastric or gastroesophageal junction (GEJ) adenocarcinoma (Press release, Astellas Pharma, MAR 21, 2023, View Source [SID1234629122]).
Schedule your 30 min Free 1stOncology Demo!
Discover why more than 1,500 members use 1stOncology™ to excel in:
Early/Late Stage Pipeline Development - Target Scouting - Clinical Biomarkers - Indication Selection & Expansion - BD&L Contacts - Conference Reports - Combinatorial Drug Settings - Companion Diagnostics - Drug Repositioning - First-in-class Analysis - Competitive Analysis - Deals & Licensing
Schedule Your 30 min Free Demo!
In the study, investigational treatment zolbetuximab plus CAPOX demonstrated a statistically significant improvement in progression-free survival (PFS) compared to placebo plus CAPOX. Specifically, zolbetuximab plus CAPOX reduced the risk of progression or death by 31.3% (n=507; hazard ratio [HR]=0.687; [95% confidence interval [CI]: (0.544-0.866)]; p=0.0007) compared to placebo plus CAPOX, meeting GLOW’s primary endpoint. Median PFS was 8.21 months (95% CI: 7.46–8.84) in the treatment arm and 6.80 months (95% CI: 6.14–8.08) in the placebo arm.
The study also showed that zolbetuximab plus CAPOX significantly prolonged overall survival (OS), a key secondary endpoint, reducing the risk of death by 22.9% (HR=0.771; 95% CI: 0.615-0.965; p=0.0118). Median OS was 14.39 months (95% CI: 12.29-16.49) and 12.16 months (95% CI: 10.28-13.67) for the treatment arm and placebo arm, respectively.
The incidence of serious treatment-emergent adverse events (TEAEs) was similar between both arms (47.2% versus 49.8% in the zolbetuximab versus placebo arms, respectively) and consistent with previous studies.1 The most frequent TEAEs in the GLOW study were nausea (68.5% versus 50.2%), vomiting (66.1% versus 30.9%) and decreased appetite (41.3% versus 33.7%) in the zolbetuximab versus placebo arms.
"The progression-free and overall survival data from GLOW demonstrate the potential of zolbetuximab in patients with CLDN18.2-positive, HER2-negative, locally advanced unresectable or metastatic gastric and gastroesophageal junction cancer," said Rui-Hua Xu, M.D., Ph.D., Professor in the Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China, and the primary investigator of GLOW. "While the treatment landscape is continuing to evolve, patients at this stage of the disease are in need of options and the GLOW data are encouraging for this patient population."
These detailed results from the GLOW trial will be presented at the March American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) Plenary Series (Wednesday, March 22, 2023, at 4:00 p.m. ET) by Manish A. Shah, M.D., Medical Oncologist and Director of the Gastrointestinal Oncology Program, Weill Cornell Medicine, New York.
"We are committed to the ongoing clinical development of zolbetuximab and to bringing new therapeutic options for patients with locally advanced unresectable or metastatic gastric or gastroesophageal junction adenocarcinoma," said Ahsan Arozullah, M.D., M.P.H., Senior Vice President and Head of Development Therapeutic Areas, Astellas. "These two statistically significant Phase 3 trials, GLOW and SPOTLIGHT, will serve as the basis for global regulatory submissions, marking remarkable progress in our gastric cancer development program."
The GLOW and SPOTLIGHT studies are a part of Astellas’ gastric cancer development program to investigate targeted treatment options such as zolbetuximab and address patient needs in locally advanced unresectable or metastatic gastric or GEJ adenocarcinoma. In both trials, approximately 38% of these patients had CLDN18.2-positive tumors (≥75% of tumor cells with strong-to-moderate membranous CLDN18.2 staining intensity), as determined by a validated immunohistochemistry assay.2
About Locally Advanced Unresectable Metastatic Gastric and Gastroesophageal Junction Cancer
Gastric cancer, also commonly known as stomach cancer, is the fifth most commonly diagnosed cancer worldwide.3 Signs and symptoms can include indigestion or heartburn, pain or discomfort in the abdomen, nausea and vomiting, diarrhea or constipation, bloating of the stomach after meals and loss of appetite and sensation of food getting stuck in the throat while eating.4 Signs of more advanced gastric cancer can include unexplained weight loss, weakness and fatigue and vomiting blood or having blood in the stool.5 Risk factors associated with gastric cancer can include older age, male gender, family history, H. pylori infection, smoking and gastroesophageal reflux disease (GERD).4,6 Because early-stage gastric cancer symptoms frequently overlap with more common stomach-related conditions, gastric cancer is often diagnosed in the advanced or metastatic stage, or once it has spread from the tumor’s origin to other body tissues or organs.4 The five-year relative survival rate for patients at the metastatic stage is approximately six percent.7 Gastroesophageal junction (GEJ) adenocarcinoma is a cancer that starts at the area where the esophagus joins the stomach.8
About Zolbetuximab
Zolbetuximab is an investigational, first-in-class chimeric IgG1 monoclonal antibody (mAb) that targets and binds to CLDN18.2, a transmembrane protein. Zolbetuximab acts by binding to CLDN18.2 on the cancer cell surface of gastric epithelial cells. In pre-clinical studies, this binding interaction then induces cancer cell death by activating two distinct immune system pathways — antibody-dependent cellular cytotoxicity (ADCC) and complement-dependent cytotoxicity (CDC).9 The safety and efficacy of zolbetuximab are under investigation in gastric, gastroesophageal junction and pancreatic cancers and have not been established. There is no guarantee the agent will receive regulatory approval or become commercially available for the uses being investigated.
About GLOW Phase 3 Clinical Trial
GLOW is a Phase 3, global, multi-center, double-blind, randomized study, assessing the efficacy and safety of zolbetuximab (IMAB362) plus CAPOX (a combination chemotherapy regimen which includes capecitabine and oxaliplatin) compared to placebo plus CAPOX as a first-line treatment of patients with CLDN18.2 positive, HER2- negative, locally advanced unresectable or metastatic gastric or gastroesophageal junction cancer. The study enrolled 507 patients at 166 study locations in the U.S., Canada, United Kingdom, Europe, South America and Asia. The primary endpoint is progression-free survival of participants treated with combination of zolbetuximab plus CAPOX compared to those treated with placebo plus CAPOX. Secondary endpoints include overall survival, objective response rate, duration of response, safety and tolerability and quality-of-life parameters.
For more information, please visit clinicaltrials.gov under Identifier NCT03653507.
About SPOTLIGHT Phase 3 Clinical Trial
SPOTLIGHT is a Phase 3, global, multi-center, double-blind, randomized study, assessing the efficacy and safety of zolbetuximab (IMAB362) plus mFOLFOX6 (combination regimen of oxaliplatin, leucovorin and fluorouracil) compared to placebo plus mFOLFOX6 as a first-line treatment of patients with CLDN18.2-positive, HER2- negative, locally advanced unresectable or metastatic gastric or gastroesophageal junction cancer. The study enrolled 565 patients at 215 study locations in the U.S., Canada, United Kingdom, Australia, Europe, South America and Asia. The primary endpoint is progression-free survival of participants treated with combination of zolbetuximab plus mFOLFOX6 compared to those treated with placebo plus mFOLFOX6. Secondary endpoints include overall survival, objective response rate, duration of response, safety and tolerability and quality-of-life parameters.
For more information, please visit clinicaltrials.gov under Identifier NCT03504397.
Pipeline in Claudin 18.2
In addition to zolbetuximab, ASP2138 is under development in our Primary Focus Immuno-Oncology.
ASP2138 is currently in a Phase 1 trial for people with gastric, gastroesophageal junction or pancreatic cancer.
For more information about ASP2138, please visit clinicaltrials.gov under Identifier NCT05365581.
An expanded Phase 2 trial (NCT03816163) in metastatic pancreatic cancer is in progress. The trial is a randomized, multi-center, open-label study, evaluating the safety and efficacy of investigational zolbetuximab in combination with gemcitabine plus nab-paclitaxel as a first-line treatment in patients with metastatic pancreatic cancer with CLDN18.2-positive tumors (defined as ≥75% of tumor cells demonstrating strong-to-moderate membranous CLDN18.2 staining based on a validated immunohistochemistry assay).