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Proffered paper session 1

2136 - CNS response to osimertinib vs standard of care (SoC) EGFR-TKI as first-line therapy in patients (pts) with EGFR-TKI sensitising mutation (EGFRm)-positive advanced non-small cell lung cancer (NSCLC): data from the FLAURA study (LBA5)

Date

18 Nov 2017

Session

Proffered paper session 1

Topics

Cytotoxic Therapy;  Targeted Therapy;  Translational Research;  Non-Small Cell Lung Cancer

Presenters

Johan Vansteenkiste

Citation

Annals of Oncology (2017) 28 (suppl_10): x186-x195. 10.1093/annonc/mdx729

Authors

J. Vansteenkiste1, T. Reungwetwattana2, K. Nakagawa3, B.C. Cho4, M.A. Cobo Dols5, E.K. Cho6, A. Bertollini7, S. Bohnet8, C. Zhou9, K.H. Lee10, N. Nogami11, I. Okamoto12, N. Leighl13, R. Hodge14, A. McKeown15, A.P. Brown16, Y. Rukazaencov17, S. Ramalingam18

Author affiliations

  • 1 Respiratory Oncology Unit (pulmonology), University Hospitals Leuven, 3000 - Leuven/BE
  • 2 Division Of Medical Oncology, Department Of Medicine, Faculty Of Medicine, Ramathibodi Hospital, Mahidol University, 10400 - Bangkok/TH
  • 3 Department Of Medical Oncology, Kindai University School of Medicine, 577-8502 - Osaka/JP
  • 4 Division Of Medical Oncology, Department Of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, 03722 - Seoul/KR
  • 5 Servicio De Oncología Médica, University Hospital Virgen de la Victoria, 29010 - Málaga/ES
  • 6 Division Of Hematology And Oncology, Department Of Internal Medicine, Gachon University Gil Medical Center, Incheon/KR
  • 7 Medical Oncology Unit, Hospital of Sondrio, Sondrio/IT
  • 8 Medizinische Klinik Iii, Universitätsklinik Schleswig-Holstein, Campus Lübeck, Lübeck/DE
  • 9 Department Of Oncology, Pulmonary Hospital of Tongji University, Shanghai/CN
  • 10 Division Of Medical Oncology, Chungbuk National University Hospital, 361-711 - Cheongju/KR
  • 11 Department Of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, 791-0280 - Matsuyama/JP
  • 12 Research Institute For Diseases Of The Chest, Graduate School Of Medical Sciences, Kyusyu University, Fukuoka/JP
  • 13 Medical Oncology, Princess Margarent Cancer Centre, M5G 2M9 - Toronto/CA
  • 14 Biostatistics And Informatics, AstraZeneca UK Ltd, Cambridge/GB
  • 15 Biostatistics And Informatics, AstraZeneca UK Ltd, Melbourn, Royston/GB
  • 16 Global Medicines Department, AstraZeneca UK Ltd, Cambridge/GB
  • 17 Research And Development, AstraZeneca UK Ltd, Cambridge/GB
  • 18 Winship Cancer Institute, Emory University, Atlanta/US
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Abstract 2136

Background

CNS metastases (mets) are common in pts with EGFRm advanced NSCLC. Osimertinib is a third-generation, CNS-active EGFR-TKI that potently and selectively inhibits both EGFRm and EGFR T790M resistance mutations. Preclinical studies have shown CNS penetration of osimertinib, and clinical data from Ph II and III trials showed CNS activity in pts with T790M-positive advanced NSCLC.

Methods

The Ph III FLAURA study (NCT02296125) compared osimertinib vs SoC EGFR-TKI in previously untreated pts with EGFRm advanced NSCLC. Pts were randomised 1:1 to osimertinib 80 mg once daily (qd) orally (po) or SoC EGFR-TKI (gefitinib 250 mg or erlotinib 150 mg qd po). Neurologically stable pts with CNS mets were allowed, provided definitive treatment/steroids were completed for ≥2 weeks. A prespecified subgroup analysis investigated CNS activity in pts with CNS mets present on baseline brain scan, as assessed by blinded independent central neuroradiology review (BICR). Endpoints included CNS progression-free survival by RECIST v1.1, CNS objective response rate and duration of CNS response. The CNS full analysis set (cFAS) included pts with ≥1 measurable and/or non-measurable CNS lesion present on baseline brain scan by BICR; the CNS evaluable for response set (cEFR) included only pts with ≥1 measurable CNS lesion.

Results

As of 12 June 2017, 128/556 pts (23%) were included in the cFAS (osimertinib: 61, SoC, 67). Baseline characteristics were balanced across treatment arms (osimertinib/SoC): female 62/61%; Asian, 66/55%, prior brain radiotherapy, 25/24%. Efficacy in the cFAS and cEFR are shown in the table:Table: LBA5

CNS efficacy endpoints, cFASOsimertinibSoC
n = 61n = 67
CNS PFS events, including death, total pts (% maturity)1830
(30)(45)
Median CNS PFS, months* (95% confidence interval)NR (16.5, NC)13.9 (8.3, NC)
CNS PFS HR (95% confidence interval)0.48 (0.26, 0.86); p = 0.014#
Confirmed CNS ORR, n (%) [95% confidence interval]35 (57) [44, 70]27 (40) [29, 53]
Odds Ratio†† (95% confidence interval)2.0 (1.0, 4.1); p = 0.053
Median CNS DoR, months (95% confidence interval)NR (11.9, NC)14.4 (8.3, 18.7)
CNS efficacy endpoints, cEFROsimertinib n = 22SoC n = 19
Confirmed CNS ORR, n (%) [95% confidence interval]17 (77) [55, 92]12 (63) [38, 84]
Odds Ratio†† (95% confidence interval)2.0 (0.5, 8.2); p = 0.322
Median CNS DoR, months (95% confidence interval)NR (8.5, NC)18.7 (4.2, 18.7)

DoR, duration of response; HR, hazard ratio; NR, not reached; ORR, objective response rate; PFS, progression-free survival

*

Median PFS with 95% confidence intervals calculated from a Cox proportional Hazard model.

A HR 1 favours osimertinib.

#

Nominally statistically significant.

Conclusions

In patients with documented CNS mets by neuroradiology BICR, osimertinib had superior CNS PFS compared to SoC, with a benefit similar to that reported in the overall group of patients. CNS response rate was higher and more durable with osimertinib.

Clinical trial identification

NCT02296125

Legal entity responsible for the study

AstraZeneca

Funding

AstraZeneca

Disclosure

J. Vansteenkiste: Personal fees (lectures and consulting) for AstraZeneca. B.C. Cho: Research funding: Novartis, Bayer, AstraZeneca, MOGAM Institute, Dong-A ST; Consulting role: Novartis, AstraZeneca, Boehringer-Ingelheim, Roche, BMS, Yuhan, Pfizer, Eli Lilly. S. Bohnet: advisory board membership. N. Nogami: Dr. Nogami reports other from AstraZeneca, other from Chugai Pharmaceutical Co., Ltd., other from Pfizer Japan Inc., other from Eli Lilly Japan K.K., other from Ono Pharmaceutical Co., LTD., other from Taiho Pharmaceutical Co., Ltd, outside the submitted work. I. Okamoto: Grants and personal fees from AstraZeneca, Ono Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Eli Lilly Japan, Taiho Pharmaceutical, Boehringer Ingelheim, and Pfizer Japan, R. Hodge: Employee and shareholder of AstraZeneca, conducts analysis of osimertinib data at AstraZeneca in addition to the submitted work. A. McKeown: Employee and shareholder: AstraZeneca. A.P. Brown: Employee and stock owner of AstraZeneca. Y. Rukazaencov: Full salaried employee of AstraZeneca and holds shares in AstraZeneca. S. Ramalingam: Advisory boards for Amgen, Astra Zeneca, Abbvie, BMS, Lilly, Celgene, Genentech, and Novartis, outside the submitted work. All other authors have declared no conflicts of interest.

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