#ESMO20 Both amivantamab (LOVE the phonetic spelling btw) and lazertinib show promising single agent activity in #EGFR NSCLC and amivantamab was granted FDA breakthrough designation for EGFRex20 NSCLC. Dual target inhibition with antibody and kinase inhibitor explored here. #LCSM
#ESMO20 CHRYSALIS is a phase I study with a dose escalation portion (established doses of amivantamab 1050mg or 1400mg based on weight given IV weekly then q2w with lazertinib 240mg once daily) and expansion in osi-resistant #EGFR NSCLC and treatment naive. #LCSM
#ESMO20 Expected patient characteristics for this patient population - note 64% deletion 19 and 36% L858R mutations. Brain metastases noted in 37% of patients. #LCSM@OncoAlert
#ESMO20 Safety shown here after median follow up of 6m. No DLTs noted in escalation. Very well tolerated with only 6% of patients stopping all therapy due to related AEs. One treatment related death - pneumonitis. G3 rash in only 4%. Infusion reactions common but mild. #LCSM
#ESMO20 In osimertinib-resistant #EGFR+ NSCLC (major unmet need), amivantamab plus lazertinib had a RR of 36% and a clinical benefit rate of 60%, seen whether osimertinib given as first line or later lines and reductions seen after PD with lazertinib. #LCSM
#ESMO20 Responses in this subset can be durable with 14/16 responses ongoing. Responses occurred early. This study is still immature and needs more follow up but very encouraging. #LCSM@OncoAlert
#ESMO20 In treatment naive #EGFR NSCLC, amivantamab plus lazertinib had a RR of 100% (n=20). Spider plot below shows rapid and deep responses with a median time to response of 1.5 months. All responses still ongoing at 7m median f/u. #LCSM@OncoAlert
#ESMO20 Very promising results with this combination. As a first line option, balance the need to receive IV infusions with a 100% RR but need more info on PFS and durability (and resistance). As a salvage option, this fills a major need today. #LCSM
#ESMO20 While osimertinib is an excellent treatment option for #EGFR NSCLC, there is notable room for improvement on the 18m mPFS. The phase 3 MARIPOSA study will be an important one. Randomization to osimertinib, lazertinib, or lazertinib plus amivantamab. #LCSM
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Dr. @marinagarassino at #WCLC24 Presidential Plenary presents Normalized Membrane Ratio of TROP2 as a biomarker for datopotamab deruxtecan in TROPION-Lung01 (Dato-DXd vs docetaxel in previously treated NSCLC which previously showed PFS benefit with Dato-DXd.
#WCLC24 TROP2 IHC has been a poor predictive marker. Normalized Membrane Ratio (NMR) factors in receptor internalization. Ratio is membrane expression over membrane plus cytoplasmic expression (using optical density from digitized slide) and lower would be more favorable.
#WCLC24 TROP2 QCS-NMR seems to be a much better predictor of benefit with datopotamab deruxtecan in BEP and in non-sq non-AGA subset: in NMR+, PFS HR 0.57 and KM shows clear separation.
Dr. Shun Lu presents interim results from the perioperative NEOTORCH study at the #ASCOPlenarySeries. Randomized pts with resectable stage II/III NSCLC to perioperative chemotherapy with toripalimab (anti-PD1) vs placebo. Another entry in the perioperative space? #LCSM
Includes resectable stage II/III (AJCC v8), EGFR/ALK wild type NSCLC. Pts receive 3 cycles of neoadjuvant chemotherapy + toripalimab vs placebo then surgery then 1 more cycle of adjuvant chemo (+tori/pbo) then 13 doses of maintenance toripalimab vs placebo. #ASCOPlenarySeries
First interim EFS analysis only for stage III. Includes 404 pts - but 926 screened. Would be interesting to see specific eligibility criteria not met in screening process. Reminder of how selected trial populations are and value of future real-world analyses. #ASCOPlenarySeries
Impressive data from #AEGEAN at #AACR23 from Dr. John Heymach and colleagues. This is the first of several phase III peri-operative IO studies in resectable NSCLC combining neoadjuvant chemo-immunotherapy followed by adjuvant immunotherapy.
Included stage IIA-IIIB (AJCC v8) with no EGFR/ALK & excluded pts who would require pneumonectomy. Large study with n=801 (CM816 was n=358). Pts received 4 cycles (not 3) of platinum-based chemo with durvalumab (anti-PDL1) or placebo, then surgery, then durvalumab / placebo x 1y.
Almost 75% received carboplatin over cisplatin. Global study; fairly even PDL1 distribution. 80% of pts went to surgery, 78% completed resection (90-95% of those were R0). Overall, 66% of pts began adjuvant phase (but 90% of those who had an R0 resection had adjuvant therapy).
There is a lot to consider in this first-line study of the #KRAS G12C inhibitor adagrasib plus pembrolizumab from #ESMOImmuno22. Some pleasant surprises in terms of safety. Definitely encouraging but need to see a bit more to be sold on this strategy. 🤔 #LCSM
We're looking for synergy with the two agents - more than an additive effect. Reason to believe there will be based on preclinical data showing the effect on T-cell infiltration from #KRAS inhibition. Similar to what has been shown with MEK inhibition. #ESMOImmuno22
The first-line dataset includes the phase Ib KRYSTAL-1 and the phase II KRYSTAL-7. In KRYSTAL-1 (n=7), 4/7 had a response and all were durable (>9m). G3 TRAEs in 4 pts (lipase elevation, LFTs, muscular pain, pneumothorax). #ESMOImmuno22
Dr. @ZPiotrowskaMD presents initial results from the ELIOS trial at #ESMO22 - molecular profiling of #EGFR mutant NSCLC after progression on 1L osimertinib.
In this study of highly motivated pts at esteemed sites, evaluable paired biopsy at PD only available in 46/115 pts (40%). Interestingly, 75 pts (65%) had paired biopsy but 27 failed NGS (23%). Speaks somewhat to the real world feasibility of a repeat biopsy approach. #ESMO22
Common co-mutations at baseline included TP53, EGFR amp, and CDKN2A loss. Acquired alterations included MET amp, EGFR C797S, ALK fusion, NKX2-1 amp. Mostly mutually exclusive. #ESMO22
Dr. Silvia Novello presents 5y update on KEYNOTE 407 (platinum plus tax and +/- pembrolizumab for 1L squamous NSCLC #ESMO22
With longer follow up, OS favors pembrolizumab arm with mOS 17.2 vs 11.6m (OS HR 0.71) in squamous NSCLC. 5y OS rate 18.4% vs 9.7%. PFS benefit (HR 0.62) and higher RR across PDL1 strata. #ESMO22
For patients who complete 2y of pembrolizumab, 3y OS rate (after completing 2y pembro) was 70% - though not all of those patients are cured (44% were alive without PD or subsequent therapy). #ESMO22