Background: Brivanib is a selective inhibitor of vascular endothelial growth factor
and fibroblast growth factor (FGF) signalling. We performed a phase II randomised discontinuation trial of brivanib in 7 tumour types (soft-tissue sarcomas [STS], ovarian cancer, breast
cancer, pancreatic cancer, non-small-cell lung cancer [NSCLC], gastric/esophageal cancer and
transitional cell carcinoma [TCC]).
Patients and methods: During a 12-week open-label lead-in period, patients received brivanib
800 mg daily and were evaluated for FGF2 status by immunohistochemistry. Patients with stable disease at week 12 were randomised to brivanib or placebo. A study steering committee
evaluated week 12 response to determine if enrolment in a tumour type would continue.
The primary objective was progression-free survival (PFS) for brivanib versus placebo in patients with FGF2-positive tumours.
Results: A total of 595 patients were treated, and stable disease was observed at the week 12
randomisation point in all tumour types. Closure decisions were made for breast cancer,
pancreatic cancer, NSCLC, gastric cancer and TCC. Criteria for expansion were met for
STS and ovarian cancer. In 53 randomised patients with STS and FGF2-positive tumours,
the median PFS was 2.8 months for brivanib and 1.4 months for placebo (hazard ratio
[HR]: 0.58, p Z 0.08). For all randomised patients with sarcomas, the median PFS was 2.8
months (95% confidence interval [CI]: 1.4e4.0) for those treated with brivanib compared with
1.4 months (95% CI: 1.3e1.6) for placebo (HR Z 0.64, 95% CI: 0.38e1.07; p Z 0.09). In the
36 randomised patients with ovarian cancer and FGF2-positive tumours, the median PFS was
4.0 (95% CI: 2.6e4.2) months for brivanib and 2.0 months (95% CI: 1.2e2.7) for placebo (HR:
0.56, 95% CI: 0.26e1.22). For all randomised patients with ovarian cancer, the median PFS in
those randomised to brivanib was 4.0 months (95% CI: 2.6e4.2) and was 2.0 months (95% CI:
1.2e2.7) in those randomised to placebo (HR Z 0.54, 95% CI: 0.25e1.17; p Z 0.11).
Conclusion: Brivanib demonstrated activity in STS and ovarian cancer with an acceptable
safety profile. FGF2 expression, as defined in the protocol, is not a predictive biomarker of
the efficacy of brivanib