Cancer Res Treat.  2021 Jan;53(1):93-103. 10.4143/crt.2020.459.

A Phase II Trial of Osimertinib as the First-Line Treatment of Non–Small Cell Lung Cancer Harboring Activating EGFR Mutations in Circulating Tumor DNA: LiquidLung-O-Cohort 1

• Park CK
• Cho HJ
• Choi YD
• Oh IJ
• Kim YC

• KMID: 2510651
• DOI: http://doi.org/10.4143/crt.2020.459

Abstract

Purpose
Osimertinib is a potent, irreversible third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor for both EGFR-activating and T790M resistant mutation. The treatment efficacy of osimertinib was assessed in previously untreated patients with metastatic non–small cell lung carcinoma (NSCLC) harboring activating EGFR mutations in circulating tumor DNA (ctDNA) as well as tumor DNA.
Materials and Methods
Patients with activating EGFR mutations in their tumor DNA underwent screening with ctDNA analysis using Mutyper and Cobas v2 assays. Enrolled subjects received osimertinib 80 mg, once daily. Primary endpoint was objective response rate (ORR) and secondary endpoints were ctDNA test sensitivity, progression-free survival (PFS), duration of response (DoR), and safety.
Results
Among 39 screened patients, 29 were ctDNA positive for activating EGFR mutations and 19 were enrolled (ex19del, n=11; L858R/L861Q, n=7; G719A, n=1). Median age was 70 and most patients had brain metastases (15/19, 79%). ctDNA test sensitivity for activating EGFR mutations was 74% using both methods and 62% (Mutyper) or 64% (Cobas v2) for individual methods. ORR was 68% (13/19), median PFS was 11.1 months (95% confidence interval [CI], 0.0 to 26.7), and median DoR was 17.6 months (95% CI, 3.5 to 31.7). ORR and median PFS were significantly superior with ex19del (91%; 21.9 months; 95% CI, 5.5 to 38.3) than with L858R/L861Q (43%; 5.1 months; 95% CI, 2.3 to 7.9). One patient discontinued the drug because of drug-related interstitial pneumonitis.
Conclusion
Osimertinib had favorable efficacy in the first-line treatment of metastatic NSCLC harboring activating EGFR mutations in ctDNA as well as tumor DNA.

Keyword

Osimertinib; mutation; Circulating tumor DNA; Non-small cell lung carcinoma

Figure

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  Fig. 1 Study subjects. ctDNA, circulating tumor DNA; EGFR-TKIs, epidermal growth factor receptor tyrosine kinase inhibitors; NSCLC, non–small cell lung cancer; RE, response-evaluable.

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  Fig. 2 Response to osimertinib. Waterfall plot (A) and Spider plot (B), according to the Response Evaluation Criteria in Solid Tumors.

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  Fig. 3 Subsequent treatment after osimertinib. Overview of the pattern of progression and subsequent treatment after osimertinib. Treatment status of enrolled patients and sequential treatment following first-line osimertinib (A). Patterns of progression after osimertinib (B). The numbers in parentheses refer to the corresponding number of patients. Swimmer plot for sequential treatment after osimertinib (C). AE, adverse event; ALK, anaplastic lymphoma kinase; CTx, chemotherapy; EGFR, epidermal growth factor receptor; LN, lymph node; PD, progressive disease; Plt, platinum; TKI, tyrosine kinase inhibitor. a)Best supportive care (n=4), death (n=1), referral to another center (n=1), b)All patients had brain metastasis at baseline, c)Death due to drug-related interstitial pneumonia.

Reference

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