Transcriptomics

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Targeting the EWS::FLI1 Transcription Factor for Ewing Sarcoma: A Phase 1/2 Study of Trabectedin and Low Dose Irinotecan (SARC037) - RNA-Seq


ABSTRACT: The EWS::FLI1 transcription factor drives the growth of Ewing sarcoma (ES). Trabectedin above a threshold concentration reverses the activity of EWS::FLI1, which is potentiated in vivo by low dose irinotecan. This open label phase 1/2 trial of trabectedin with irinotecan enrolled 37 relapsed/refractory ES patients (SARC037; NCT04067115). The recommended phase 2 dose (RP2D) was trabectedin 1.0 mg/m2 over 1 hour (Day 1) and irinotecan 25 mg/m2 (Days 2 & 4) of 21-day cycle. Toxicities were manageable with >Grade 3 toxicities (>15%) of myelosuppression and ALT elevations at RP2D. The phase 2 objective response rate was 33% (39%, including RP2D phase 1 patients) and 6-month PFS was 48%. Transcriptional profiling demonstrated reversal of the EWS::FLI1 transcriptome in tumors from a subset of patients. Additional correlative objectives captured molecular profiling, ctDNA levels, and 18F-FLT PET avidity. The combination of trabectedin and irinotecan is active in ES and suppresses its driver, EWS::FLI1.

ORGANISM(S): Homo sapiens

PROVIDER: GSE322664 | GEO | 2026/03/02

REPOSITORIES: GEO

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