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CNS response to osimertinib in patients with T790M-positive advanced NSCLC: pooled data from two phase II trials
G Goss1, C-M Tsai2, F A Shepherd3
1Division of Medical Oncology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
Background:
Central nervous system (CNS) metastases are common in patients with non-small-cell lung cancer (NSCLC). Osimertinib has shown systemic efficacy in patients with CNS metastases, and early clinical evidence shows efficacy in the CNS. To evaluate osimertinib activity further, we present a pre-specified subgroup analysis of CNS response using pooled data from two phase II studies: AURA extension (NCT01802632) and AURA2 (NCT02094261).
Patients And Methods:
Patients with T790M-positive advanced NSCLC, who had progressed following prior epidermal growth factor receptor-tyrosine kinase inhibitor treatment, received osimertinib 80 mg od (n = 411). Patients with stable, asymptomatic CNS metastases were eligible for enrolment; prior CNS treatment was allowed. Patients with ≥1 measurable CNS lesion (per RECIST 1.1) on baseline brain scan by blinded independent central neuroradiology review (BICR) were included in the evaluable for CNS response set (cEFR). The primary outcome for this CNS analysis was CNS objective response rate (ORR) by BICR; secondary outcomes included CNS duration of response, disease control rate (DCR) and progression-free survival (PFS).
Results:
Of 128 patients with CNS metastases on baseline brain scans, 50 were included in the cEFR. Confirmed CNS ORR and DCR were 54% [27/50; 95% confidence interval (CI) 39-68] and 92% (46/50; 95% CI 81-98), respectively. CNS response was observed regardless of prior radiotherapy to the brain. Median CNS duration of response (22% maturity) was not reached (range, 1-15 months); at 9 months, 75% (95% CI 53-88) of patients were estimated to remain in response. Median follow-up for CNS PFS was 11 months; median CNS PFS was not reached (95% CI, 7, not calculable). The safety profile observed in the cEFR was consistent with the overall patient population.
Conclusions:
Osimertinib demonstrated clinically meaningful efficacy against CNS metastases, with a high DCR, encouraging ORR, and safety profile consistent with that reported previously.
Clinicaltrials.Gov Number:
NCT01802632; NCT02094261.
Insights
Osimertinib shows significant efficacy in treating central nervous system (CNS) metastases in non-small-cell lung cancer (NSCLC) patients. The drug achieved a high disease control rate and objective response rate in patients with brain metastases.
Area of Science:
- Oncology
- Medical Research
- Clinical Trials
Background:
- Central nervous system (CNS) metastases are a frequent complication in non-small-cell lung cancer (NSCLC).
- Osimertinib has demonstrated systemic effectiveness in NSCLC patients with CNS metastases.
- Early evidence suggests Osimertinib's efficacy within the CNS.
Purpose of the Study:
- To evaluate the efficacy of Osimertinib in patients with CNS metastases from NSCLC.
- To present a subgroup analysis of CNS response using pooled data from two Phase II studies (AURA extension and AURA2).
Main Methods:
- Patients with T790M-positive advanced NSCLC and stable, asymptomatic CNS metastases were treated with Osimertinib 80 mg once daily.
- A total of 411 patients received Osimertinib; 50 patients with measurable CNS lesions were included in the CNS response evaluable set (cEFR).
- Primary endpoint was CNS objective response rate (ORR); secondary endpoints included CNS duration of response, disease control rate (DCR), and progression-free survival (PFS).
Main Results:
- The confirmed CNS ORR was 54% (27/50), and the CNS DCR was 92% (46/50).
- CNS response was observed irrespective of prior brain radiotherapy.
- Median CNS duration of response was not reached; 75% of patients remained in response at 9 months. Median CNS PFS was also not reached.
Conclusions:
- Osimertinib demonstrated clinically meaningful efficacy against CNS metastases in NSCLC.
- The drug achieved a high DCR and encouraging ORR.
- The safety profile in patients with CNS metastases was consistent with the overall population.
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