Trastuzumab deruxtecan (DS-8201) in patients with HER2-expressing metastatic colorectal cancer (DESTINY-CRC01): a multicentre, open-label, phase 2 trial

Background HER2 amplification has been identified in 2-3% of patients with colorectal cancer, although there are currently no approved HER2-targeted therapies for colorectal cancer. We aimed to study the antitumour activity and safety of tra stuzurnab deruxtecan (an antibody-drug conjugate of humanised a nti-H ER2 antibody with topoisoinerase I inhibitor payloads) in patients with HER2-expressing metastatic colorectal cancer. Methods DESTINY-CRCO1 is an open-label, phase 2 study that recruited patients from 25 clinics and hospitals in Italy, Japan, Spain, the UK, and the USA. Eligible patients had centrally confirmed HER2-expressing inetastatic colorectal cancer that had progressed on two or more previous regimens (HER2-targeted therapies other than trastuzumab denixtecan permitted), were aged 18 years or older (>= 20 years in Japan), had an Eastern Cooperative Oncology Group score of 0 or 1, and had RAS and BRAF(V600E) wild-type tumours. Patients were enrolled into one of three cohorts by HER2 expression level: cohort A (HER2-positive, immunohistochemistry [IHCJ 3+ or IHC2+ and in-situ hybridisation [ISH1-positive), cohort B (IHC2+ and ISH-negative), or cohort C (IHC1+). Patients received 6.4 mg/kg trastuzumab deruxtecan intravenously every 3 weeks until disease progression, unacceptable adverse events, withdrawal of consent, or death. The primary endpoint was confirmed objective response rate in cohort A by independent central review which was assessed in the full analysis set and safety was assessed in the safety analysis set. Both the full analysis set and the safety analysis set included all patients who received one or more doses of trastuzumab denixtecan. This ongoing trial is registered with ClinicalTrials.gov, number NCT03384940. Findings Between Feb 23, 2018, and July 3, 2019, 78 patients were enrolled in the study (53 in cohort A, seven in cohort B, and 18 in cohort C), all of whom received at least one dose of study drug. For the 53 (68%) patients with HER2-positive tumours (cohort A), a confirmed objective response was reported in 24 (45.3%, 95% CI 31.6-59.6) patients after a median follow-up of 27.1 weeks (IQR 19.3-40.1). Grade 3 or worse treatment-emergent adverse events that occurred in at least 10% of all participants were decreased neutrophil count (17 [22%] of 78) and anaemia (11 [14%]). Five patients (6%) had adjudicated interstitial lung disease or pneumonitis (two grade 2; one grade 3; two grade 5, the only treatment-related deaths). Interpretation Trastuzumab deruxtecan showed promising and durable activity in HER2-positive metastatic colorectal cancer refractory to standard treatment, with a safety profile consistent with that reported in previous trastuzumab deruxtecan trials. Interstitial lung disease and prieuinonitis are important risks requiring careful monitoring and prompt intervention. Copyright (C) 2021 Published by Elsevier Ltd. All rights reserved.