Everolimus for advanced pancreatic neuroendocrine tumours: a subgroup analysis evaluating Japanese patients in the RADIANT-3 trial

• Published in: Japanese journal of clinical oncology 2012-10, Vol.42 (10), p.903-911
• Main Authors: Ito, Tetsuhide, Okusaka, Takuji, Ikeda, Masafumi, Igarashi, Hisato, Morizane, Chigusa, Nakachi, Kohei, Tajima, Takeshi, Kasuga, Akio, Fujita, Yoshie, Furuse, Junji
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Clinical Trials, Phase III as Topic; Double-Blind Method; Everolimus; Female; Follow-Up Studies; Humans; Immunosuppressive Agents - therapeutic use; Male; Middle Aged; Neoplasm Staging; Neuroendocrine Tumors - drug therapy; Neuroendocrine Tumors - mortality; Original; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - mortality; Prognosis; Randomized Controlled Trials as Topic; Sirolimus - analogs & derivatives; Sirolimus - therapeutic use; Survival Rate; Young Adult
• ISSN: 0368-2811; 1465-3621
• DOI: 10.1093/jjco/hys123

Everolimus, an inhibitor of the mammalian target of rapamycin, has recently demonstrated efficacy and safety in a Phase III, double-blind, randomized trial (RADIANT-3) in 410 patients with low- or intermediate-grade advanced pancreatic neuroendocrine tumours. Everolimus 10 mg/day provided a 2.4-fold improvement compared with placebo in progression-free survival, representing a 65% risk reduction for progression. The purpose of this analysis was to investigate the efficacy and safety of everolimus in the Japanese subgroup enrolled in the RADIANT-3 study. Subgroup analysis of the Japanese patients was performed comparing efficacy and safety between everolimus 10 mg/day orally (n = 23) and matching placebo (n = 17). The primary endpoint was progression-free survival. Safety was evaluated on the basis of the incidence of adverse drug reactions. Progression-free survival was significantly prolonged with everolimus compared with placebo. The median progression-free survival was 19.45 months (95% confidence interval, 8.31-not available) with everolimus vs 2.83 months (95% confidence interval, 2.46-8.34) with placebo, resulting in an 81% risk reduction in progression (hazard ratio, 0.19; 95% confidence interval, 0.08-0.48; P< 0.001). Adverse drug reactions occurred in all 23 (100%) Japanese patients receiving everolimus and in 13 (77%) patients receiving placebo; most were grade 1/2 in severity. The most common adverse drug reactions in the everolimus group were rash (n = 20; 87%), stomatitis (n = 17; 74%), infections (n = 15; 65%), nail disorders (n = 12; 52%), epistaxis (n = 10; 44%) and pneumonitis (n = 10; 44%). These results support the use of everolimus as a valuable treatment option for Japanese patients with advanced pancreatic neuroendocrine tumours.