Clinical activity of transforming growth factor-β inhibitor vactosertib in combination with imatinib in desmoid tumors: a multicenter phase Ib/II study

Summary

Purpose: To determine to the activity and safety of TGF-β inhibitor, vactosertib in combination with imatinib in patients with desmoid tumors. Patients and methods: In this investigator-initiated, open-label, multicenter, phase Ib/II trial, patients with desmoid tumors not amendable to locoregional therapies (surgery and/or radiotherapy) or with disease progression following at least one treatment were enrolled. Participants were administered 400 mg imatinib daily in combination with vactosertib (5 days on and 2 days off, twice a day) every 28 days. In phase Ib, the vactosertib dose was set at 100 mg (level -1) and 200 mg (level 1) to determine the recommended phase II dose (RP2D). Phase II assessed the efficacy, with the primary endpoint being progression-free rate (PFR) at 16 weeks. Results: No dose-limiting toxicities were observed during the phase Ib, therefore RP2D was defined at doses of 400 mg imatinib daily in combination with 200 mg vactosertib. Of the 27 patients evaluated, 7 (25.9%) achieved a confirmed partial response and 19 (70.4%) were stable. The PFR at 16 weeks and 1 year were 96.3% and 81.0%, respectively. The most toxicities were mild to moderate myalgia (n=10, 37%), anemia (n=10, 37%), and nausea (n=9, 33.3%). Common grade 3-4 toxicities included neutropenia (n=6, 22.2%) and anemia (n=5, 18.5%). Conclusions: Vactosertib and imatinib combination was well-tolerated, with promising clinical activity in patients with progressive, locally advanced desmoid tumors. This is the first study investigating a novel target agent, a TGF-β inhibitor, in this rare and difficult-to-treat desmoid tumor.