Pralatrexate in combination with oxaliplatin in advanced esophago-gastric cancer: a phase II trial with predictive molecular correlates

The purpose of our study was to evaluate the efficacy of a combination of pralatrexate plus oxaliplatin in advanced Esophago-Gastric cancer (EGC), analyze the impact of polymorphisms in folate metabolism pathway genes on toxicity and efficacy of pralatrexate and to evaluate microRNA profile of tumor epithelium as a predictive biomarker. This was a two-stage trial with a safety lead in cohort and a primary endpoint of overall response rate (ORR). Patients received biweekly intravenous oxaliplatin (85 mg/m2) and pralatrexate (Dose level 1 [D1], 120 mg/m2; dose level -1 [D-1] 100 mg/m2). Single nucleotide polymorphisms (SNPs) in genes encoding proteins involved in pralatrexate metabolism were evaluated in germline DNA. microRNA profiling of the tumor epithelium was performed. ORR was 26%. Dose limiting toxicities were observed in 2/4 patients at D1 and none at D-1. The T>C polymorphism in DHFR rs11951910 was significantly associated with lower progression-free-survival (PFS) (p ≤ 0.01) while the presence of the SLC19A1 rs2838957 G>A polymorphism was associated with improved PFS (p=0.02). Presence of the GGH rs3780130 A>T and SLC19A1 rs1051266 G>A polymorphisms were significantly associated with better overall survival (OS) (p=0.01) while GGH rs7010484 T>C polymorphism was associated significantly with reduced OS (p=0.04). There was no correlation between epithelial microRNA expression profile with disease progression or response. We conclude that the combination of oxaliplatin and pralatrexate is safe, well tolerated and has modest efficacy in advanced EGC. Pharmacogenomic analysis may be relevant to the use of pralatrexate in combination with platinum agents.