Evaluation of the potential for QTc prolongation with avelumab

Abstract

Purpose: To report integrated electrocardiogram (ECG) summary and exposure-QTc analyses for avelumab, a human immunoglobulin G1 monoclonal antibody that binds programmed cell death 1 ligand 1, to assess potential effects on cardiac repolarization.

Methods: Data were pooled from three-phase 1/2 studies of patients with advanced solid tumors who received avelumab monotherapy (22,000 ECGs from 1818 patients). All analyses used 12-lead singlet ECGs taken using local ECG machines before and approximately 2 h after avelumab infusion on prespecified days. The exposure-QTc and outlier analyses used locally read ECGs; since larger variability is known to be associated with local reading, outlier ECGs were subsequently reevaluated by central read. QTc derived from Fridericia's formula (QTcF) and a project-specific formula (QTcP) were analyzed. Multivariable linear mixed-effects models were used to describe the relationship between serum concentration of avelumab and QTc absolute value or change from baseline (ΔQTc).

Results: Exposure-QTc models showed that the effect of avelumab on QTc or ΔQTc was minimal and not statistically significant for both QTcP and QTcF. In addition, models including avelumab concentration and diphenhydramine premedication use did not show a clinically meaningful effect on the QT interval. The frequency of QTc outliers in both short and long ranges was overestimated by local reads. Six patients (0.3%) were QTc outliers; all had either received concomitant medication known to cause QT prolongation or had a preexisting cardiac condition.

Conclusion: Avelumab does not have any clinically relevant effect on cardiac repolarization.

Keywords: Avelumab; Cancer; PD-L1; QT interval; QTc; Solid tumor.

Fig. 1

Regression of a baseline QT interval vs baseline RR interval (n = 1780, P < 0.0001^a, r = 0.7912), b baseline QTcF interval vs baseline RR interval (n = 1780, P < 0.0001^a, r = 0.1982), or c baseline QTcP interval vs baseline RR interval (n = 1780, P =0.9024^a, r = − 0.0029). QTcF, QTc derived from Fridericia’s formula; QTcP, QTc derived from a project-specific formula. ^aRefers to test of r = 0