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Baseline AFP levels were <200 ng/mL: 53% Lenvima : 60% Nexavar

The median baseline AFP level:133.1 ng/m Lenvima : 71.2 ng/mL Nexavar

¥­§¡±µ¨üªvÀøªº®É¶¡--5.7¤ëLenvima : 3.7¤ëNexavar

mOS= 13.6¤ëLenvima : 12.3¤ëNexavar(p>0.05)

¬Ý¤@¤UsubgroupªºmOS

¡´Baseline AFP levels were <200 ng/mL

mOS= 19.5¤ëLenvima : 16.3¤ëNexavar(p>0.05)

¡´Baseline AFP levels were >=200 ng/mL

mOS= 10.4¤ëLenvima : 8.2¤ëNexavar(p>0.05)

mPFS= 7.4¤ëLenvima : 3.7¤ëNexavar(p<0.00001)

TTP¥­§¡´_µo= 8.9¤ëLenvima : 3.7¤ëNexavar(p<0.00001)

ORR= 24.1%Lenvima : 9.2% Nexavar(p<0.00001)---¡´À³¸Ó¬O¥ÎmRECIST¡AASCOªººK­n¨S¥æ¥N¡´

¨ä¤¤CR= 1.3%Lenvima : 0.4% Nexavar---¡´À³¸Ó¬O¥ÎmRECIST¡AASCOªººK­n¨S¥æ¥N¡´

¤j©óGrade 3ªº°Æ§@¥Î57%Lenvima vs 49%Nexavar

°ª¦åÀ£23%:14%, Åé­«¤U­°8%:3%,¦å¤pªO¤U­°6%:3%, ­¹¼¤¤U­°5%:1%---¡´¥i¨£lenvima¬O«Ü¬rªºÃÄ¡´

aspartate aminotransferase¤W¤É5%:8%,

diarrhea4%:4%

palmar-plantar erythrodysesthesia3%:11%.

¦]ÃĪ«°Æ§@¥Î¦Ó»Ý­n´îÃĪº¯f¤H¡÷ 37%Lenvima : 38%Nexavar---¡´¥i¨£lenvima¬O«Ü¬rªºÃÄ¡´

¦]ÃĪ«°Æ§@¥Î¦Ó»Ý­n°±ÃĪº¯f¤H¡÷ 9%Lenvima : 7%Nexavar---¡´¥i¨£lenvima¬O«Ü¬rªºÃÄ¡´

Lenvatinib phase3 ªº°Ñ¦Ò¸ê®Æ½Ð¬Ý¤U­±¡G

Lenvatinib OS Noninferior, PFS Improved Versus Sorafenib for Unresectable HCC

4 Jun 2017 ASCO

¼ÐÃD»¡OS¤£¤ñNexavar®t¡APFS¤ñNexavar¦n¡I¡I¡I

ªÖ©w¦Û¤v-----ADI+FOLFOX

1. ÃĮĦn¡I----¨ì¥Ø«eADI+FOLFOXªº¼Æ¾Ú

ORR=5/22 (22.7%)¡A¨ä¤¤CR=1/22(4.5%)¡APR=4/22(18.2%)

±qDCR=59%¥i¤Ï±À¥XSD=8/22(36.4%)

¡´­«ÂI¤¤ªº­«ÂI¡÷¡÷¡÷ADI+FOLFOX¬O¥ÎRECIST 1.1¡´

2. ¬r©Ê§C¡I

Â^¨ú¤@¬qADI+FOLFOX Phase I ªº¤º®e

A phase I study of mFOLFOX6 and ADI-PEG-20 in patients (pts) with advanced hepatocellular

carcinoma (HCC) and other gastrointestinal (GI) malignancies

Treatment-related grade 3 laboratory adverse events (AEs) occurred in 47% of pts,

including neutropenia (4), thrombocytopenia (3), anemia (2), lymphocytopenia (2) and

hyponatremia (1).

47%ªº¯f¤H¡A±q©â¦åÀËÅç¼Æ¾Ú¬Ý¦³¤j©óµ¥©ó3¯Åªº°Æ§@¥Î¡A¨ä¤¤4¦ì¬O¤¤©Ê²y¤U­°¡B3¦ì¦å¤pªO¤U­°¡B

2¦ì³h¦å¡B2¦ì²O¤Ú²y¤U­°¡B1¦ì§C¦å¶u¡C

¡´ª`·N¬O±q©â¦åÀËÅç¼Æ¾Ú¬Ý¡´

³o¼Ëªº¼Æ¾Ú¦b¤ÆÀøªº¯f¤H¬O«Ü±`¨£ªº¡A¯f¤HµL¤£¾A¡A¥B¦h¬°FOLFOXªº¬r©Ê¡I

Treatment-related grade 3 clinical AEs occurred in 2 pts, notably grade 3 fatigue and a

grade 3 cardiac event not otherwise specified.

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No dose limiting toxicities, treatment-related deaths, or cases of hepatic failure were observed.

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1. Mai Investment Co., Limited 40,527(«ùªÑ±i¼Æ) 19.61%(«ùªÑ¤ñ)

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4. Generations Technology Corporation 19,514 9.44%

5. Sun Research Groups Limited 7,636 3.65%

6. Atman Fund II LP 7,050 3,41%

7. Iconluck Limited 7,000 3.39%

8. G-Technology Investment Co., Ltd 5,996 2.90%

9. Golden Miracle International Limited 5,717 2.77%

10.Moral Star International Limited 4,087 1.98%

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1. Mai Investment Co., Limited 40,527(«ùªÑ±i¼Æ) 19.61%(«ùªÑ¤ñ)

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4. Generations Technology Corporation 19,514 9.44%

5. Iconluck Limited 7,000 3.39%

6. Sun Research Groups Limited 6,536 3.16%

7. G-Technology Investment Co., Ltd 5,996 2.90%

8. Golden Miracle International Limited 5,617 2.72%

9. Moral Star International Limited 4,087 1.98%

10.Locust Road Group Ltd. 3,504 1.70%

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1.Llovet JM, Decaens T, Raoul JL, et al. Brivanib in patients with advanced hepatocellular

carcinoma who were intolerant to sorafenib or for whom sorafenib failed: results from the

randomizedphase III BRISK-PS study. J Clin Oncol 2013; 31: 3509¡V16.

2. Zhu AX, Kudo M, Assenat E, et al. Eff ect of everolimus on survival in advanced hepatocellular

carcinoma after failure of sorafenib:the EVOLVE-1 randomized clinical trial. JAMA 2014; 312: 57¡V67.

3. Zhu AX, Park JO, Ryoo BY, et al. Ramucirumab versus placebo as second-line treatment in

patients with advanced hepatocellular carcinoma following fi rst-line therapy with sorafenib (REACH):

a randomised, double-blind, multicentre, phase 3 trial. Lancet Oncol 2015; 16: 859¡V70.

4. Abou-Alfa GK, Qin S, Ryoo BY, et al. Phase III randomized study of second-line ADI-peg 20 (A)

plus best supportive care versus placebo (P) plus best supportive care in patients (pts)

with advanced hepatocellular carcinoma (HCC). Proc Am Soc Clin Oncol 2016;34: abstr 4017.

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Sorafenib therapy in advanced hepatocellular carcinoma: the SHARP trial

Expert Rev Anticancer Ther 2009 P739-745

¥¿¸Ñ¤G¡GLenvatinib(Lenvima)478­Ó¯f¤H¡AORR=24.1%(¨ä¤¤CR¥u¦³1.3%)---¡´À³¸Ó¬O¥ÎmRECIST¡AASCOªººK­n¨S¥æ¥N¡´

mOS=13.6­Ó¤ë¡FmPFS= 7.4­Ó¤ë¡FTTP= ¥­§¡8.9­Ó¤ë´_µo

¤j©óGrade 3ªº°Æ§@¥Î57%¡÷°ª¦åÀ£23%, Åé­«¤U­°8%,¦å¤pªO¤U­°6%, aspartate aminotransferase¤W¤É5%,

­¹¼¤¤U­°5%, diarrhea4%,palmar-plantar erythrodysesthesia3%.

Lenvatinib phase3 ªº°Ñ¦Ò¸ê®Æ½Ð¬Ý¤U­±¡G

Lenvatinib OS Noninferior, PFS Improved Versus Sorafenib for Unresectable HCC---¼ÐÃD¥u´±¤U¤£¤ñNexavar®t¡I¡I¡I

4 Jun 2017 ASCO

ÁöµM¦b4 Jun 2017 ASCO¡ALenvatinib(Lenvima)¨Ã¨S¦³»¡ORR¬O¥ÎRECIST or mRECIST¡A¦ý¬O¥LªºPhase II

study¬O¥ÎmRECIST(46­Ó¯f¤H)¡A¦P®É¤]´£¨Ñ­Y¥ÎRECISTªº¸ê®Æ¡C

¥H¤U¬O¨äPhase II ORRªºmRECIST and RECISTªº¤ñ¸û

mRECIST¤H(%) and RECIST¤H(%)

CR 0 (0) 0 (0)

PR 17 (37) 11 (24)

SD 19 (41) 25 (54)

PD 6 (13) 6 (13)

NE 4 (9) 4 (9)

ORR 17 (37) ¡´11 (24)¡´-----±q³o¸Ì¬Ý¯uªº¤£¿éADI+FOLFOX¡A¦ý¬O¬r©Ê¤ñ¸û¤j¡I

DCR 36 (78) 36 (78)

Lenvatinib phase2 ªº°Ñ¦Ò¸ê®Æ½Ð¬Ý¤U­±¡G

Phase 2 study of lenvatinib in patients with advanced hepatocellular carcinoma

J Gastroentero, 2017 Pl512-519----¤µ¦~¤~µoªíphase 2ªº½×¤å¡Aphase 3À³¸Ó­nµ¥¨ì2020¦~¤F~

¡´¨ì¥Ø«eADI+FOLFOXªº¼Æ¾Ú¡´

ORR=5/22 (22.7%)¡A¨ä¤¤CR=1/22(4.5%)¡APR=4/22(18.2%)¡F±qDCR=59%¥i¤Ï±À¥XSD=8/22(36.4%)

­«ÂI¤¤ªº­«ÂI¡÷¡÷¡÷ADI¨S¦³¼Ä¤H¡I¡I¡I¥i¥H¦P¥ô¦óÃĦX¨Ö¨Ï¥Î¡I¡I¡I«e¤Q¤jÃļt¦³´X®a·|¤ß°Ê¡H¡H¡H

¥¿¸Ñ¤T¡GOpdivo¥Ø«e¤~­è§¹¦¨PhaseI/II¡A¨Ã¤£¬O>500¤H¡A¬O262¤H(48¦ìdose-escalation phase¬Ý¬r©Ê¡A

214¦ìdose-expansion phase¬ÝORR)¡A¨ä¤¤202/262(77%)ªº¯f¤H¦³§¹¾ã±µ¨üªvÀø¡A12/48(25%)¦³Grade 3/4

ªº°Æ§@¥Î¡A30/48(63%)ªº¯f¤H¦bdose-escalation phase¦º¤`¡A¦bdose-expansion phaseªºORR 20%¡A¦ý¬O

¦b¡´dose-escalation phase®ÉORR¥u¦³15%¡´¡C---¬O¥ÎRECIST 1.1---³oÂI«Ü­«­n¡I

214¦ìdose-expansion phase¸Ô²Óªº¼Æ¾Ú¬O¡G

CR=3/214(1%) ; PR=39/214(18%) ; SD=96/214(45%) ;

DCR= 138/214(64%)¡A¦ý¬O¬¡¶W¹L6­Ó¤ëªºDCR= 79/214(37%)

¡´6­Ó¤ëªº¦s¬¡²vOS=83%; 9­Ó¤ëªº¦s¬¡²vOS=74%; PFS¥u¦³4­Ó¤ë¡I¡´---Phase I/II¥»¨Ó´N¤£±`¥HOS,PFS¬°primary endpoint¡I

¦A²Î­pdose-expansion phase n=174¤Hªºsubgroup

PD-L1>1%ªº¦³30/174(20%)ªºORR=9/34(26%)

PD-L1<1%ªº¦³140/174(80%)ªºORR=26/140(19%)

¡´½Ð¦Û°ÝOpdivo¤@¾¯¦h¤Ö¿ú¡H¦³¦h¤Ö¤H¥Î±o°_¡H¡´§AÁÙ·|ı±oADI+FOLFOX¨S¦³Ävª§¤O¶Ü¡H

Opdivoªº°Ñ¦Ò¸ê®Æ½Ð¬Ý¤U­±¡G

Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate 040): an open-label,

non-comparative, phase 1/2 dose escalation and expansion trial

Lancet 2017 p-2492-2502

3. FOLFOXªº°Æ§@¥Î¤w¤£¤p¡A¨S¦³¬Ý¨ì¥_·¥¬P¤½¥q¤½§iADI+FOLFOX phase Iªº°Æ§@¥Î¡H

¥¿¸Ñ¡GÂ^¨ú¤@¬qADI+FOLFOX Phase I ªº¤º®e

A phase I study of mFOLFOX6 and ADI-PEG-20 in patients (pts) with advanced hepatocellular

carcinoma (HCC) and other gastrointestinal (GI) malig

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§ó¥¿¹ï·Ó²Õ doxorubicin ¬°187¤H.
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¤µ¤Ñ§Ú­Ì¨Ó²á¤@²á¼vÅT¥_·¥¬P¥¼¨Óªº¬ÛÃöÃĪ«¡Aª¾¤v ¦Ó«á.... ª¾©¼ ¦Ó«á....

¬J¨¥ADI+FOLFOX¡A·íµM­n¥ý¤F¸ÑFOLFOX

FOLFOX¤£¬O¤@ºØÃÄ¡A¬O¤@ºØ²Õ¦Xªº³B¤è,US FDA¦b9 Jan 2004®Ö­ã¥Î©óadvanced colorectal cancer

FOL¡V Folinic acid (leucovorin)

F ¡V Fluorouracil (5-FU)

OX ¡V Oxaliplatin (Eloxatin)(­ìÃÄ°Ó¬°Sanofi¡A¥@¬É±Æ¦W²Ä¤E¤jÃÄ°Ó¡A¸Ó¤½¥q¦~¾P°âÃB¬ù130»õ¬ü¤¸)

12 Mar 2013 CFDA§å­ã¡A¥Î©ó¡u¤£¾A¦X¤â³N¤Á°£©Î§½³¡ªvÀøªº§½³¡±ß´Á©MÂಾªº¨x²Ó­MÀùªºªvÀø¡vªº¤@½u¥ÎÃÄ

¤£¦Pªº¾¯¶q°t¤è¦³¤£¦Pªº¥N¸¹¡A¦pFOLFOX6ªºª`®g¶¶§Ç¬O

The dose schedule given every two weeks is as follows:

Day 1¡V2: Oxaliplatin 100 mg/m² IV infusion, given as a 120 minutes IV infusion in 500 mL D5W,

concurrent with leucovorin 400 mg/m² (or levoleucovorin 200 mg/m²) IV infusion, followed by

5-FU 400 mg/m² IV bolus, followed by 46-hour 5-FU infusion (2400 mg/m² for first two cycles,

increased to 3000 mg/m² in case of no toxicity > grade 1 during the first two cycles).

Days 3¡V14: Rest days

Antiemetic prophylaxis with 5-HT3-receptor antagonist.

­ìµÛ½×¤å

Randomized, multicenter, open-label study of oxaliplatin plus fluorouracil/leucovorin versus

doxorubicin as palliative chemotherapy in patients with advanced hepatocellular carcinoma

from Asia

°Ñ»PªÌ

Mainland China, Taiwan, Korea, and Thailand 371¦ìlocally advanced or metastatic HCC¯f¤H¡A age 18 to 75 years

¹êÅç²Õ FOLFOX4 (184)¡G¹ï·Ó²Õ doxorubicin (87).

¤èªk

Primary end point=overall survival (OS)

secondary end points=free survival (PFS), response rate (RR) by RECIST 1.0, and safety.

µ²ªG

Median OS= FOLFOX4 6.40 mon (95% CI, 5.30~7.03)¡Gdoxorubicin 4.97 mon(95% CI, 4.23 to 6.03;

P=.07; hazard ratio [HR], 0.80; 95% CI, 0.63 to 1.02).

Median PFS= FOLFOX4 2.93 mon (95% CI, 2.43 to 3.53)¡Gdoxorubicin 1.77 months(95% CI, 1.63 to 2.30;

P=.001; HR, 0.62; 95% CI, 0.49 to 0.79).

RR= FOLFOX4 8.15% ¡Gdoxorubicin 2.67% (P=.02).

ÃĪ«¬r©Ê

Toxicity was consistent with previous experiences with FOLFOX4;

proportions of grade 3 to 4 adverse events were similar between treatments.

µ²½×

Although the study did not meet its primary end point, the trend toward improved OS with

FOLFOX4, along with increased PFS and RR, suggests that this regimen may confer some benefit

to Asian patients, but an OS benefit cannot be concluded from these data.

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J Clin Oncol 31:3501-3508.

¦A¨Ó½Æ²ß¤@¤UADI+FOLFOX6 PhaseI study

A phase I study of mFOLFOX6 and ADI-PEG-20 in patients (pts) with advanced hepatocellular

carcinoma (HCC) and other gastrointestinal (GI) malignancies.

17¤HHCC (13), pancreatic (3) & fibrolamellar carcinoma (1)

folfox6¡AADI IM 18 or 36mg/m2 weekly

13 HCC ¤¤ 3 (23%) PR, 6 (46%) SD, 3 PD and 1 NE

Arginine levels

mean ¡Ó SEM: baseline 85.3 ¡Ó 13.0 uM, 8 wks«á 4 ¡Ó 3.0 uM, 16 wk«á 1.1 ¡Ó 0.8uM.

Anti-ADI-PEG-20 antibodies

mean ¡Ó SEM: baseline 0.7 ¡Ó 0.5, 8 wks 1.5 ¡Ó 1

±q¨xÀù¤T´Á¥¢±Ñ«á¡ASubgroupªºÄ_¶Q¸gÅç¬Ý¡G¥u­nArg depletion>7wks

Median OS

12.5¤ë(>7wks²Õ): 6.3¤ë(<7wks²Õ)--P<.001

¦A¬Ý106/07/04ªº¤½¥q¤½§i

¤@´ÁÁ{§É¸ÕÅ穵¦ù¬°ÃöÁä©Ê¥þ²yÁ{§É¸ÕÅç¡A

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»PFOLFOX¨â²Õªº¤ñ¨ÒÀË©w¬Û¤ñ

FOLFOX 8.15% : ADI+FOLFOX ?¡÷184¤H:184¤H, p value 0.05, Power=0.8(¦]¬°FOLFOXªº½×¤å¥Î0.8)

µª®×¬OADI+FOLFOX= 17.96%

Power­Y¥Î0.9ºâ«hADI+FOLFOXªºORR»Ý¹F19.8%

¦pªGADI+FOLFOX¥u¥Î169¤H«hORR»Ý¹F20.09%

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²Ä¤Q½b¡÷¤½¥q³QEli Lilly, Johnson&Johnson, Sanofi, Gilead Sciences, AbbVie, Bayer, Merck,

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1. MPMªºincidence= ¬ù20/¦Ê¸U¤H

2. ¥i¬ÝMPM Phase II/IIIclinical trialªºinclusion criteria¡÷ advanced MPM(¥½´Á)ªºbiphasic

type or sarcomatoid type.

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biphasic (epithelioid+sarcomatoid, ¦U¦Û³£­n¶W¹L10%¤~¯à©w¸q¬°biphasic)

clinicaltrials.gov/ct2/show/NCT02709512?term=Adi-peg&rank=12

Inclusion Criteria:

1.Histologically proven advanced MPM of biphasic or sarcomatoid histology. Biphasic MPM is

defined using the World Health Organization¡¦s international histological classification of

tumors as containing an epithelial and a sarcomatoid component with each component

comprising at least 10% of the tumor

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(2015/2016¨xÀù¤T´ÁADI-PEG 20 ³æ¤@Àøªk¥¢±Ñ)

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1. ¬JµM¦³¥Î©Î¨S¥Î¹LSorafenib(¹p¨F¥Ë)¡A¨â²Õ³£¨S¦³®t²§¡A¨º©Ç¸oSorafenib(¹p¨F¥Ë)¡A¹ï¶Ü¡H

2. Exposure to Sorafenib(¹p¨F¥Ë)¦h¤[¤~¤£·|³y¦¨¤½¥qªº±À½×¡HÁ`±o¦³­Ó®É¶¡§a¡H¥u­n¥´¹L¡A´N¨S¦³®Ä¤F¡H¥»¨Ó¬OASS1 deficiencyªºtumor cell´N·|¤@ª½³£¬O¬ðÅܫ᪺¦³ASSªº¡H

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2017 Gastrointestinal Cancers Symposium

A phase I study of mFOLFOX6 and ADI-PEG-20 in patients (pts) with advanced hepatocellular carcinoma (HCC) and other gastrointestinal (GI) malignancies.

17¤HHCC (13), pancreatic (3) & fibrolamellar carcinoma (1)

folfox 6¾¯¡AADI IM 18 or 36mg/m2 weekly

13 HCC ¤¤ 3 (23%) PR, 6 (46%) SD, 3 PD and 1 NE

Arginine levels

mean ¡Ó SEM: baseline 85.3 ¡Ó 13.0 uM, 8 wks«á 4 ¡Ó 3.0 uM,

16 wk«á 1.1 ¡Ó 0.8uM.

Anti-ADI-PEG-20 antibodies

mean ¡Ó SEM: baseline 0.7 ¡Ó 0.5, 8 wks 1.5 ¡Ó 1

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Phase IB trial of ADI-PEG 20 (A) plus nab-paclitaxel (nab-P) and gemcitabine (gem) in patients with advanced pancreatic cancer (PC).

gem 1,000 mg/m2, nab-P 125mg/m2, 3 out of 4 weeks, ADI 18 mg IM weekly (cohort 1), A 36mg weekly (cohort 2 and expansion cohort)

Primary endpoint: determine MTD (maximum tolerated dose)³Ì¤j¥i©Ó¨üªº¾¯¶q

Statistical plan: Single arm, non-randomized, open-label, phase IB, standard 3 + 3 dose escalation with expansion ct of 9 patients at MTD

Secondary endpoints: progression-free survival (PFS), response rate, overall survival (OS), safety, tolerability, blood and archival tumor analyses for ASS expression and immunogenicity

Response: 6 pts (40%) PR, 8 pts (53%) stable disease (SD), 1 pt in-evaluable.

median PFS 6.5 months (95% CI 5.3 ¡V 15.2), median OS 11.3 months (95% CI 4.9- . ).

Five of 11 archival tumors samples tested for ASS1 expression by IHC were deficient.

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