Activity of crizotinib in patients with ALK-aberrant relapsed/refractory neuroblastoma: A children’s oncology group study (ADVL0912)

Jennifer H. Foster, Stephan D. Voss, David C. Hall, Charles G. Minard, Frank M. Balis, Keith Wilner, Stacey L. Berg, Elizabeth Fox, Peter C. Adamson, Susan M. Blaney, Brenda J. Weigel, Yael P. Mossé

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Abstract

PURPOSE: Anaplastic lymphoma kinase (ALK) aberrations are a promising target for patients with neuroblastoma. We assessed the activity of first-generation ALK inhibitor crizotinib in patients with no known curative treatments and whose tumors harbored an activating ALK alteration.

PATIENTS AND METHODS: Twenty patients with relapsed/refractory ALK-positive neuroblastoma received crizotinib at the recommended phase II dose of 280 mg/m 2/dose. A Simon two-stage design was used to evaluate the antitumor activity of crizotinib monotherapy. Response evaluation occurred after cycles 1, 3, 5, 7, and then every 3 cycles. Correlation of ALK status and response was a secondary aim of the study.

RESULTS: The objective response rate for patients with neuroblastoma was 15% [95% confidence interval (CI): 3.3%-34.3%]: two with partial responses and 1 with a complete response. All three patients had a somatic ALK Arg1275Gln mutation, the most common ALK hotspot mutation observed in neuroblastoma and the only mutation predicted to be sensitive to ALK inhibition with crizotinib. Two patients had prolonged stable disease (10 and 13 cycles, respectively); both harbored an ALK Arg1275Gln mutation. Three patients with ALK Phe1174Leu mutations progressed during cycle 1 of therapy, and one patient with an ALK Phe1174Val received three cycles before disease progression. The two patients with ALK amplification had no response. The most common adverse event was a decrease in neutrophil count.

CONCLUSIONS: Despite limited activity seen in this trial, we conclude that this is more likely due to an inability to reach the higher concentrations of crizotinib needed to overcome the competing ATP affinity. See related commentary by Schulte and Eggert, p. 3507.

Original languageEnglish (US)
Pages (from-to)3543-3548
Number of pages6
JournalClinical Cancer Research
Volume27
Issue number13
DOIs
StatePublished - Jul 1 2021

Bibliographical note

Funding Information:
This research was supported by the NCI of the NIH under award number UM1 CA097452 and UM1 CA228823, Cookies for Kids? Cancer Foundation, the Children?s Oncology Group Foundation, and Pfizer, Inc.

Funding Information:
This research was supported by the NCI of the NIH under award number UM1 CA097452 and UM1 CA228823, Cookies for Kids’ Cancer Foundation, the Children’s Oncology Group Foundation, and Pfizer, Inc.

Publisher Copyright:
© 2021 American Association for Cancer Research.

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