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Rociletinib in EGFR-mutated non-small-cell lung cancer
Lecia V Sequist1, Jean-Charles Soria, Jonathan W Goldman
1From Massachusetts General Hospital (L.V.S., R.S.H., J.L., Z.P.), Harvard Medical School (L.V.S., G.R.O., R.S.H., Z.P.), and Dana-Farber Cancer Institute (G.R.O.) - all in Boston; the Drug Development Department, Université Paris-Sud, Gustave Roussy Cancer Campus (J.-C.S.), and Institut Gustave Roussy (A.V.), Villejuif - both in France; the David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G., E.B.G., M.A.M., S.N.), and Stanford Cancer Institute, Stanford University, Stanford (H.A.W., J.W.N.) - both in California; the Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit (S.M.G., C.G., A.J.W.); University of Texas M.D. Anderson Cancer Center, Houston (V.P.); the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (B.J.S.); the Medical University of Gdansk, Gdansk, Poland (R.D.); the University of Colorado (D.L.A., D.R.C.) and University of Colorado Cancer Center (R.C.D.) - both in Aurora; and Clovis Oncology, San Francisco (M.R., C.A.K., S.J.-T., S.L.M., A.R.A.), Boulder, CO (J.I., D.D.), and Cambridge, United Kingdom (L.R.).
Background:
Non-small-cell lung cancer (NSCLC) with a mutation in the gene encoding epidermal growth factor receptor (EGFR) is sensitive to approved EGFR inhibitors, but resistance develops, mediated by the T790M EGFR mutation in most cases. Rociletinib (CO-1686) is an EGFR inhibitor active in preclinical models of EGFR-mutated NSCLC with or without T790M.
Methods:
In this phase 1-2 study, we administered rociletinib to patients with EGFR-mutated NSCLC who had disease progression during previous treatment with an existing EGFR inhibitor. In the expansion (phase 2) part of the study, patients with T790M-positive disease received rociletinib at a dose of 500 mg twice daily, 625 mg twice daily, or 750 mg twice daily. Key objectives were assessment of safety, side-effect profile, pharmacokinetics, and preliminary antitumor activity of rociletinib. Tumor biopsies to identify T790M were performed during screening. Treatment was administered in continuous 21-day cycles.
Results:
A total of 130 patients were enrolled. The first 57 patients to be enrolled received the free-base form of rociletinib (150 mg once daily to 900 mg twice daily). The remaining patients received the hydrogen bromide salt (HBr) form (500 mg twice daily to 1000 mg twice daily). A maximum tolerated dose (the highest dose associated with a rate of dose-limiting toxic effects of less than 33%) was not identified. The only common dose-limiting adverse event was hyperglycemia. In an efficacy analysis that included patients who received free-base rociletinib at a dose of 900 mg twice daily or the HBr form at any dose, the objective response rate among the 46 patients with T790M-positive disease who could be evaluated was 59% (95% confidence interval [CI], 45 to 73), and the rate among the 17 patients with T790M-negative disease who could be evaluated was 29% (95% CI, 8 to 51).
Conclusions:
Rociletinib was active in patients with EGFR-mutated NSCLC associated with the T790M resistance mutation. (Funded by Clovis Oncology; ClinicalTrials.gov number, NCT01526928.).
Insights
Rociletinib demonstrated activity in non-small-cell lung cancer (NSCLC) patients with the T790M resistance mutation. This EGFR inhibitor showed promising antitumor effects in a phase 1-2 study.
Area of Science:
- Oncology
- Pharmacology
Background:
- Non-small-cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations is initially responsive to EGFR inhibitors.
- Acquired resistance to EGFR inhibitors, often mediated by the T790M mutation, is a significant clinical challenge.
- Rociletinib is an investigational EGFR inhibitor designed to target EGFR mutations, including T790M.
Purpose of the Study:
- To evaluate the safety, tolerability, pharmacokinetics, and preliminary antitumor activity of rociletinib in patients with EGFR-mutated NSCLC.
- To assess rociletinib's efficacy in patients who developed resistance to prior EGFR inhibitor therapy, specifically investigating the impact of the T790M mutation.
Main Methods:
- A Phase 1-2 clinical trial administered rociletinib to patients with EGFR-mutated NSCLC who had progressed on existing EGFR inhibitors.
- Patients in the Phase 2 expansion cohort with T790M-positive disease received rociletinib at doses of 500 mg, 625 mg, or 750 mg twice daily.
- Tumor biopsies were used to identify T790M status, and treatment was administered in 21-day cycles.
Main Results:
- The study enrolled 130 patients, with varying doses and forms of rociletinib administered.
- Hyperglycemia was the primary dose-limiting adverse event; a maximum tolerated dose was not identified.
- An objective response rate of 59% was observed in T790M-positive patients, compared to 29% in T790M-negative patients.
Conclusions:
- Rociletinib exhibits significant activity in patients with EGFR-mutated NSCLC harboring the T790M resistance mutation.
- These findings support rociletinib's potential as a treatment option for NSCLC patients with acquired resistance to EGFR inhibitors.
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