Blood-based extracellular matrix biomarkers as predictors of survival in patients with metastatic pancreatic ductal adenocarcinoma receiving pegvorhyaluronidase alfa.

Abstract

BACKGROUND:

Extensive extracellular matrix (ECM) remodeling is a hallmark of metastatic pancreatic ductal adenocarcinoma (mPDA). We investigated fragments of collagen types III (C3M, PRO-C3), VI (PRO-C6), and VIII (C8-C), and versican (VCANM) in plasma as biomarkers for predicting progression-free survival (PFS) and overall survival (OS) in patients with mPDA treated with pegvorhyaluronidase alfa, a biologic that degrades the ECM component hyaluronan (HA), in a randomized phase 2 study (HALO109-202).

METHODS:

HALO109-202 comprised a discovery cohort (Stage 1, n = 94) and a validation cohort (Stage 2, n = 95). Plasma ECM biomarkers were analyzed by ELISAs. Univariate Cox regression analysis and Kaplan-Meier plots evaluated predictive associations between biomarkers, PFS and OS in patients treated with pegvorhyaluronidase alfa plus nab-paclitaxel/gemcitabine (PAG) versus nab-paclitaxel/gemcitabine (AG) alone.

RESULTS:

PFS was improved with PAG vs. AG in Stage 1 patients with high C3M/PRO-C3 ratio (median cut-off): median PFS (mPFS) 8.0 vs. 5.3 months, P = 0.031; HR = 0.40; 95% CI 0.17-0.92). High C3M/PRO-C3 ratio was validated in Stage 2 patients by predicting a PFS benefit of PAG vs. AG (mPFS: 8.8 vs. 3.4 months, P = 0.046; HR = 0.46; 95% CI 0.21-0.98). OS was also improved in patients with high C3M/PRO-C3 ratio treated with PAG vs. AG (mOS 13.8 vs 8.5 months, P = 0.009; HR = 0.35; 95% CI 0.16-0.77). Interestingly, high C3M/PRO-C3 ratio predicted for a PFS benefit to PAG vs. AG both in patients with HA-low tumors (HR = 0.36; 95% CI 0.17-0.79) and HA-high tumors (HR = 0.20; 95% CI 0.06-0.69).

CONCLUSIONS:

The C3M/PRO-C3 ratio measuring type III collagen turnover in plasma has potential as a blood-based predictive biomarker in patients with mPDA and provides additional value to a HA biopsy when applied for patient selection.

TRIAL REGISTRATION:

NCT01839487. Registered 25 April 2016.

• Authors: Song Wang, Cecilie L Bager, Morten A Karsdal, Dimitrios Chondros, Darin Taverna, Nicholas Willumsen
• Journal: Journal of translational medicine (J Transl Med) Vol. 19 Issue 1 Pg. 39 (01 21 2021) ISSN: 1479-5876 [Electronic] England
• PMID: 33478521 (Publication Type: Clinical Trial, Phase II, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Albumins
• Biomarkers
• Hyaluronoglucosaminidase
• PEGPH20
• Paclitaxel

Topics

• Adenocarcinoma
• Albumins (therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols
• Biomarkers
• Extracellular Matrix
• Humans
• Hyaluronoglucosaminidase
• Paclitaxel (therapeutic use)
• Pancreatic Neoplasms (drug therapy)