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E-Poster Display

1294P - RELAY, erlotinib plus ramucirumab or placebo in untreated EGFR-mutated metastatic NSCLC: Outcomes by EGFR mutation type


17 Sep 2020


E-Poster Display


Kazuhiko Nakagawa


Annals of Oncology (2020) 31 (suppl_4): S754-S840. 10.1016/annonc/annonc283


K. Nakagawa1, E. Nadal2, E.B. Garon3, M. Nishio4, T. Seto5, N. Yamamoto6, K. Park7, J. Shih8, B. Frimodt-Moller9, A.H. Zimmermann10, C.M. Visseren-Grul11, M. Reck12

Author affiliations

  • 1 Medical Oncology, Kindai University School of Medicine, 577-8502 - Osaka/JP
  • 2 Medical Oncology, ICO - Institut Català d'Oncologia l'Hospitalet (Hospital Duran i Reynals), 08908 - L’Hospitalet de Llobregat, Barcelona/ES
  • 3 Medicine, David Geffen School of Medicine, UCLA/TRIO-US Network, 90404 - Los Angeles/US
  • 4 Medical Oncology, Cancer Institute Hospital of JFCR, 135-8550 - Tokyo/JP
  • 5 Department Of Thoracic Oncology, National Kyushu Cancer Center, 811-1395 - Fukuoka/JP
  • 6 Internal Medicine, Wakayama Medical University, 641-8509 - Wakayama/JP
  • 7 Div. Of Heamatology/oncology, Medicine, Samsung Medical Center (SMC)-Sungkyunkwan University School of Medicine, 135-710 - Seoul/KR
  • 8 Internal Medicine, National Taiwan University Hospital, 100 - Taipei city/TW
  • 9 Medical Development, Eli Lilly, 2880 - Copenhagen/DK
  • 10 Biometrics, Eli Lilly and Company, Indianapolis/US
  • 11 Medical Development, Eli Lilly Netherlands, 3528 BJ - Utrecht/NL
  • 12 Thoracic Oncology Dept., Krankenhaus Grosshansdorf, 22927 - Grosshansdorf/DE


Abstract 1294P


In EGFR mutated, metastatic (met) NSCLC, outcomes from EGFR tyrosine kinase inhibitors (TKIs) have differed historically by mutation (mut) type present, with lower benefit reported in pts with an exon 21 L858R (ex21) versus (v) an exon 19 deletion (ex19). In the phase 3 RELAY trial, RAM+ERL provided a superior PFS v PBO+ERL (Nakagawa K, et al, Lancet Oncol. 2019.20:1655-69). Additional efficacy and safety by mut type are reported here for the first time.


Pts with untreated met NSCLC, an EGFR ex19 or ex21 mut, and no CNS mets were randomized (1:1) to receive erlotinib (150 mg/day) with either ramucirumab (10 mg/kg) (RAM+ERL) or placebo (PBO+ERL), Q2W, until RECIST1.1-defined progression or unacceptable toxicity. Stratification factors included mut type (ex19/ex21) and region (East Asia/Other). The primary endpoint was PFS. Secondary and exploratory endpoints included ORR, DCR, DOR, safety, PFS2, and biomarker analyses. Statistical analyses included Cox regression and Kaplan-Meier estimation. Adverse events were evaluated using NCI-CTCAE 4.0.


More pts with ex21 v ex19 (83% v 72%) were of Asian race. PFS, ORR, and DCR showed consistent improvements across mut types for RAM+ERL v PBO+ERL (Table). The safety profile (Grade ≥3, serious AEs, dose adjustments) was similar between the mut types. Exploratory data are forthcoming. Table: 1294P

Ex19 Ex21
RAM+ERL (n=123) PBO+ERL (n=120) RAM+ERL (n=99) PBO+ERL (n=105)
Median, months 19.6 12.5 19.4 11.2
HR* (95% CI)*; Log-rank p-value* 0.651 (0.469-0.903); p=0.01 0.618 (0.437-0.874); p=0.006
1yr PFS rate, % 74 54 70 47
ORR, % 79 83 74 66
DCR, % 96 96 95 95
DOR n responders 97 99 73 69
Median, months 18.2 11.0 16.2 11.1
HR (95% CI)* 0.542 (0.380-0.772) 0.731 (0.493-1.083)

PFS, progression free survival; ORR, objective response rate; DCR, disease control rate; DOR, duration of response; HR, hazard ratio Median follow-up time = 20.7 mo (range, 0.1-35.4) *unstratified.


RAM+ERL-treated pts with ex21 mut had similar treatment benefit as pts with ex19 mut, which was consistent with that of the ITT. The safety profiles were as expected. These results support RAM+ERL as a first-line therapy for both ex19 and ex21-positive met NSCLC.

Clinical trial identification


Editorial acknowledgement

Susan P. Whitman, PhD, a full-time employee of Eli Lilly and Company, provided medical writing and editing support for this work.

Legal entity responsible for the study

Eli Lilly and Company.


Eli Lilly and Company.


K. Nakagawa: Honoraria (institution), Research grant/Funding (institution): MSD KK, Eli Lilly Japan, BMS, Taiho Pharma; Honoraria (institution), Research grant/Funding (institution): Ono Pharmaceutical, Chugai Pharma, AZ KK, Astellas Pharma; Research grant/Funding (institution): Merck Serono, IconJapan, Parexel international, IQVIA Services, A2 Healthcare, AbbVie; Honoraria (institution), Research grant/Funding (institution): Novartis Pharma KK, Nipon BI, Pfizer Japan, ; Honoraria (institution), Research grant/Funding (institution): Takeda,Symllio Pharmaceuticals, Daiichi Sanyo; Honoraria (institution), Research grant/Funding (institution): Linical Co, Otsuka Pharma, EPSInternational; Honoraria (self), Honoraria (institution): Quintiles, CMIC Shift Zero KK, Eisai Co, Kissei Pharma, Kyowa HakkoKirin, EPS Corp, Bayer Yakuhin, ; Honoraria (self), Honoraria (institution): Inventiv Health Japan, Gritsone Oncology, GlaxoSmithKline KK, Yakult Honsha, Covance; Honoraria (self), Honoraria (institution): Kyorin, CArenet, Nichi-Iko, Hisamitsu,Yodosha, ClinicalTrial Co, Medicus Shuppan, Ayumi Pharmaceutical, Nikkei business publications, ; Honoraria (self), Honoraria (institution): Thermo Fisher KK, Nanzando, Medical Review Co, Yomiuri Telecasting Corp, Reno Medical KK. E. Nadal: Travel/Accommodation/Expenses: Eli Lilly; Advisory/Consultancy: Lilly, Roche, AZ, BI. E.B. Garon: Research grant/Funding (institution): AZ, BMS, Eli Lilly, Genentech, Merck, Novartis, Iovance, Neon, Dynavax Mirati; Honoraria (self), Honoraria (institution): Dracen, EMD Serono. M. Nishio: Honoraria (institution), Research grant/Funding (institution): Eli Lilly; Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): Ono, BMS. T. Seto: Research grant/Funding (institution): Eli Lilly; Honoraria (self), Honoraria (institution), Research grant/Funding (institution): Astellas, AZ, Chugai. N. Yamamoto: Honoraria (self), Honoraria (institution): Eli Lilly, Chugai, Pfizer, ONO,AZ, ; Research grant/Funding (institution): Lilly, Chugai, Quintiles, Pfizer, Astellas,Daiichyo Sankyo, Esai, Novartis, Kyowa-Hakko Kirin,Taiho, BI. K. Park: Advisory/Consultancy: Amgen, Astellas, Bluprint, BI,Eli Lilly,GSK Hanmi, KHK,MSD, BMS,ONO, Roche, Merck KGaA, Loxo; Advisory/Consultancy, Research grant/Funding (institution): AZ. J-Y. Shih: Advisory/Consultancy, Speaker Bureau/Expert testimony: AZ, Novartis, ONO, AbbVie; Speaker Bureau/Expert testimony: ELi Lilly; Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Roche, BI, Pfizer, MSD,BMS; Advisory/Consultancy: AbbVie. B. Frimodt-Moller: Shareholder/Stockholder/Stock options, Full/Part-time employment: Eli Lilly. A.H. Zimmermann: Shareholder/Stockholder/Stock options, Full/Part-time employment: Eli Lilly. C.M. Visseren-Grul: Shareholder/Stockholder/Stock options, Full/Part-time employment: Eli Lilly. M. Reck: Honoraria (institution), Advisory/Consultancy: AbbVie, Amgen, AZ,BMS, BI; Honoraria (institution), Advisory/Consultancy: Celgene, Merck, MSD, Novartis,Pfizer, Roche.

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