Skip to main content

Nirogacestat, a γ-Secretase Inhibitor for Desmoid Tumors.

Publication ,  Journal Article
Gounder, M; Ratan, R; Alcindor, T; Schöffski, P; van der Graaf, WT; Wilky, BA; Riedel, RF; Lim, A; Smith, LM; Moody, S; Attia, S; Chawla, S ...
Published in: N Engl J Med
March 9, 2023

BACKGROUND: Desmoid tumors are rare, locally aggressive, highly recurrent soft-tissue tumors without approved treatments. METHODS: We conducted a phase 3, international, double-blind, randomized, placebo-controlled trial of nirogacestat in adults with progressing desmoid tumors according to the Response Evaluation Criteria in Solid Tumors, version 1.1. Patients were assigned in a 1:1 ratio to receive the oral γ-secretase inhibitor nirogacestat (150 mg) or placebo twice daily. The primary end point was progression-free survival. RESULTS: From May 2019 through August 2020, a total of 70 patients were assigned to receive nirogacestat and 72 to receive placebo. Nirogacestat had a significant progression-free survival benefit over placebo (hazard ratio for disease progression or death, 0.29; 95% confidence interval, 0.15 to 0.55; P<0.001); the likelihood of being event-free at 2 years was 76% with nirogacestat and 44% with placebo. Between-group differences in progression-free survival were consistent across prespecified subgroups. The percentage of patients who had an objective response was significantly higher with nirogacestat than with placebo (41% vs. 8%; P<0.001), with a median time to response of 5.6 months and 11.1 months, respectively; the percentage of patients with a complete response was 7% and 0%, respectively. Significant between-group differences in secondary patient-reported outcomes, including pain, symptom burden, physical or role functioning, and health-related quality of life, were observed (P≤0.01). Frequent adverse events with nirogacestat included diarrhea (in 84% of the patients), nausea (in 54%), fatigue (in 51%), hypophosphatemia (in 42%), and maculopapular rash (in 32%); 95% of adverse events were of grade 1 or 2. Among women of childbearing potential receiving nirogacestat, 27 of 36 (75%) had adverse events consistent with ovarian dysfunction, which resolved in 20 women (74%). CONCLUSIONS: Nirogacestat was associated with significant benefits with respect to progression-free survival, objective response, pain, symptom burden, physical functioning, role functioning, and health-related quality of life in adults with progressing desmoid tumors. Adverse events with nirogacestat were frequent but mostly low grade. (Funded by SpringWorks Therapeutics; DeFi ClinicalTrials.gov number, NCT03785964.).

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

N Engl J Med

DOI

EISSN

1533-4406

Publication Date

March 9, 2023

Volume

388

Issue

10

Start / End Page

898 / 912

Location

United States

Related Subject Headings

  • Valine
  • Tetrahydronaphthalenes
  • Quality of Life
  • Progression-Free Survival
  • Humans
  • General & Internal Medicine
  • Gamma Secretase Inhibitors and Modulators
  • Fibromatosis, Aggressive
  • Female
  • Double-Blind Method
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Gounder, M., Ratan, R., Alcindor, T., Schöffski, P., van der Graaf, W. T., Wilky, B. A., … Kasper, B. (2023). Nirogacestat, a γ-Secretase Inhibitor for Desmoid Tumors. N Engl J Med, 388(10), 898–912. https://doi.org/10.1056/NEJMoa2210140
Gounder, Mrinal, Ravin Ratan, Thierry Alcindor, Patrick Schöffski, Winette T. van der Graaf, Breelyn A. Wilky, Richard F. Riedel, et al. “Nirogacestat, a γ-Secretase Inhibitor for Desmoid Tumors.N Engl J Med 388, no. 10 (March 9, 2023): 898–912. https://doi.org/10.1056/NEJMoa2210140.
Gounder M, Ratan R, Alcindor T, Schöffski P, van der Graaf WT, Wilky BA, et al. Nirogacestat, a γ-Secretase Inhibitor for Desmoid Tumors. N Engl J Med. 2023 Mar 9;388(10):898–912.
Gounder, Mrinal, et al. “Nirogacestat, a γ-Secretase Inhibitor for Desmoid Tumors.N Engl J Med, vol. 388, no. 10, Mar. 2023, pp. 898–912. Pubmed, doi:10.1056/NEJMoa2210140.
Gounder M, Ratan R, Alcindor T, Schöffski P, van der Graaf WT, Wilky BA, Riedel RF, Lim A, Smith LM, Moody S, Attia S, Chawla S, D’Amato G, Federman N, Merriam P, Van Tine BA, Vincenzi B, Benson C, Bui NQ, Chugh R, Tinoco G, Charlson J, Dileo P, Hartner L, Lapeire L, Mazzeo F, Palmerini E, Reichardt P, Stacchiotti S, Bailey HH, Burgess MA, Cote GM, Davis LE, Deshpande H, Gelderblom H, Grignani G, Loggers E, Philip T, Pressey JG, Kummar S, Kasper B. Nirogacestat, a γ-Secretase Inhibitor for Desmoid Tumors. N Engl J Med. 2023 Mar 9;388(10):898–912.

Published In

N Engl J Med

DOI

EISSN

1533-4406

Publication Date

March 9, 2023

Volume

388

Issue

10

Start / End Page

898 / 912

Location

United States

Related Subject Headings

  • Valine
  • Tetrahydronaphthalenes
  • Quality of Life
  • Progression-Free Survival
  • Humans
  • General & Internal Medicine
  • Gamma Secretase Inhibitors and Modulators
  • Fibromatosis, Aggressive
  • Female
  • Double-Blind Method