AstraZeneca visar positiva data på ASCO för AZD9291 för behandling av EGFR-muterad lungcancer

The data from the first-line expansion cohorts of the AURA Phase I study were presented at the annual meeting of the American Society of Clinical Oncology in Chicago. The first-line cohorts included 60 patients with EGFRm advanced NSCLC who received AZD9291 80mg or 160mg once daily. The data are not fully mature with an approximate 11 month median follow up in the 80mg cohort, and an approximate 8.5 month median follow up in the 160mg cohort. The most common adverse events in both cohorts included rash (Grade 3: 0% at 80mg, 3% at 160mg) and diarrhoea (Grade 3: 0% at 80mg, 7% at 160mg).1

“These preliminary data demonstrate the potential of AZD9291 in treatment-naïve advanced NSCLC patients with EGFR mutation. These promising results with AZD9291 will be studied further by the ongoing Phase III FLAURA trial2 in the first-line setting,” said Professor Suresh S. Ramalingam, Chief of Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA, who presented the AURA 1L data and is lead principal investigator for the FLAURA study.

The first-line data from the AURA study build on findings presented in April at the European Lung Cancer Congress (ELCC). Data presented at ELCC showed that previously treated patients with EGFRm advanced NSCLC who also have the T790M resistance mutation achieved a median progression-free survival (PFS) of 13.5 months (95% CI 8.3 months to not calculable) on AZD9291 80mg once daily, based on 38% of patients having tumour progression.3 Patients with EGFRm NSCLC are particularly sensitive to treatment with currently available EGFR tyrosine kinase inhibitors (TKIs). However, tumours almost always develop resistance to treatment, leading to disease progression. In approximately two thirds of patients treated with the approved EGFR-TKIs, gefitinib or erlotinib, this resistance is caused by the secondary T790M mutation.4

Antoine Yver, Head of Oncology, Global Medicines Development, said: “The promising response to first-line treatment with AZD9291 builds on the encouraging efficacy already seen in patients with EGFRm advanced NSCLC who have the T790M resistance mutation, and whose disease has progressed following previous treatment with first-generation EGFR tyrosine kinase inhibitors. We have just been granted accelerated assessment for our upcoming regulatory submission for AZD9291 in Europe. We remain confident that AZD9291 has the potential to deliver early and durable efficacy by targeting both activating and resistance EGFR mutations.”

AZD9291 is being investigated across different lines of therapy, both as monotherapy and in combination with other small molecule and immuno-oncology investigational medicines, to understand its potential benefit for overcoming newly-identified forms of resistance for a broader range of patients. The ongoing TATTON study will investigate the combination of MEDI4736 (anti-PD-L1 immune checkpoint inhibitor), selumetinib (MEK inhibitor), or savolitinib (MET inhibitor; AZD6094) in lung cancer. Data presented at ASCO from the TATTON study showed that AZD9291 has a tolerable safety profile, supporting its investigation in potentially synergistic combinations with other molecules.5 A Phase III study (CAURAL) investigating AZD9291 in combination with MEDI4736 as a potential second-line treatment for EGFRm NSCLC patients with the T790M resistance mutation is also planned to start later this year, as part of AstraZeneca’s combination focused development strategy.

An expanded access programme (EAP) for AZD9291 for patients with advanced or metastatic EGFRm, T790M NSCLC has also been initiated in the U.S. Healthcare professionals based in the U.S. seeking more information about the AZD9291 EAP can call 1-800-236-9933. Further information on the EAP is available at www.clinicaltrials.gov (ClinicalTrials.gov identifier: NCT02451852). Additional access programmes will be opened outside of the US shortly and details will be released when information becomes available.

AZD9291 and MEDI4736 are investigational products and are not approved for any indication in any market by any regulatory authority.

References:

[1] Ramalingam SS et al. AZD9291, A mutant-selective EGFR inhibitor, as first-line treatment for EGFR mutation-positive advanced non-small cell lung cancer (NSCLC): Results from a phase 1 expansion cohort. J Clin Oncol 2015; 33 (suppl; abstr 8000). Data on file [Atlas ID: 787,626.011].

2 Ramalingam SS et al. A randomized, Phase III study (FLAURA) of AZD9291, a novel EGFR-TKI, versus gefitinib or erlotinib in treatment-naïve patients with advanced non-small cell lung cancer and an EGFR-sensitizing mutation. J Clin Oncol 2015; 33 (suppl; abstr TPS8102).

3 Jänne PA, et al. A Phase I study of AZD9291 in patients with EGFR-TKI-resistant advanced NSCLC – updated progression-free survival and duration of response data Ann Oncol 2015; 26(Suppl 1): i60, abs LBA3.

4 Yu H, et al, Analysis of Tumor Specimens at the Time of Acquired Resistance to EGFR-TKI Therapy in 155 Patients with EGFR-Mutant Lung Cancers. Clin Cancer Res. 2013:19:2240-7.

5 Oxnard GR et al. Preliminary results of TATTON, a multi-arm phase Ib trial of AZD9291 combined with MEDI4736, AZD6094 or selumetinib in EGFR-mutant lung cancer. J Clin Oncol 2015; 33 (suppl; abstr 2509).

6 Cross DA, et al. AZD9291, an irreversible EGFR TKI, overcomes T790M-mediated resistance to EGFR inhibitors in lung cancer. Cancer Discov. 2014;4:1046-61.

7 Szumera-Ciećkiewicz A, et al. EGFR mutation testing on cytological and histological samples in non-small cell lung cancer: a Polish, single institution study and systematic review of European incidence. Int J Clin Exp Pathol. 2013;6:2800-12.

8 Ellison G, et al. EGFR mutation testing in lung cancer: a review of available methods and their use for analysis of tumour tissue and cytology samples. J Clin Pathol. 2013;66:79-89.

9 Sharma SV, et al. Epidermal growth factor receptor mutations in lung cancer. Nat Rev Cancer. 2007;7:169-81.

10 Mok TS, et al. Gefitinib or Carboplatin-Paclitaxel in Pulmonary Adenocarcinoma. N Engl J Med. 2009;361:947-57.

11 Rosell R, et al. Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial. Lancet Oncol. 2012;13:239–46.