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Efficacy and Safety of Limertinib (ASK120067) in Patients With Locally Advanced or Metastatic EGFR Thr790Met-Mutated
Yuankai Shi1, Baolan Li2, Lin Wu3
1Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, People's Republic of China.
Introduction:
Limertinib (ASK120067) is a newly developed third-generation EGFR tyrosine kinase inhibitor targeting both sensitizing EGFR and EGFR Thr790Met (T790M) mutations. This study aimed to evaluate the efficacy and safety of limertinib in patients with locally advanced or metastatic EGFR T790M-mutated NSCLC.
Methods:
This is a single-arm, open-label, phase 2b study conducted at 62 hospitals across the People's Republic of China. Patients with locally advanced or metastatic NSCLC with centrally confirmed EGFR T790M mutations in tumor tissue or blood plasma who progressed after first- or second-generation EGFR tyrosine kinase inhibitors or with primary EGFR T790M mutations were enrolled. Patients received limertinib 160 mg orally twice daily until disease progression or unacceptable toxicity. The primary end point was objective response rate (ORR) assessed by independent review committee per the Response Evaluation Criteria in Solid Tumors version 1.1. Secondary end points included disease control rate, progression-free survival (PFS), duration of response (DoR), overall survival, and safety. Safety was assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03.
Results:
From July 16, 2019, to March 10, 2021, a total of 301 patients were enrolled and started the treatment of limertinib. All patients entered the full analysis set and safety set. By the data cutoff date on September 9, 2021, 76 (25.2%) remained on treatment. The median follow-up time was 10.4 months (range: 0.3-26.3). On the basis of full analysis set, the independent review committee-assessed ORR was 68.8% (95% confidence interval [CI]: 63.2%-74.0%) and disease control rate was 92.4% (95% CI: 88.8%-95.1%). The median PFS was 11.0 months (95% CI: 9.7-12.4), median DoR was 11.1 months (95% CI: 9.6-13.8), and median OS was not reached (95% CI 19.7 months-not evaluable). Objective responses were achieved across all prespecified subgroups. For 99 patients (32.9%) with central nervous system (CNS) metastases, the ORR was 64.6% (95% CI: 54.4%-74.0%), median PFS was 9.7 months (95% CI: 5.9-11.6), and median DoR was 9.6 months (95% CI: 8.1-15.2). For 41 patients who had assessable CNS lesion, the confirmed CNS-ORR was 56.1% (95% CI: 39.7%-71.5%) and median CNS-PFS was 10.6 months (95% CI: 5.6-not evaluable). In safety set, 289 patients (96.0%) experienced at least one treatment-related adverse event (TRAE), with the most common being diarrhea (81.7%), anemia (32.6%), rash (29.9%), and anorexia (28.2%). Grade ≥3 TRAEs occurred in 104 patients (34.6%), with the most common including diarrhea (13.0%), hypokalemia (4.3%), anemia (4.0%), and rash (3.3%). TRAEs leading to dose interruption and dose discontinuation occurred in 24.6% and 2% of patients, respectively. No TRAE leading to death occurred.
Conclusions:
Limertinib (ASK120067) was found to have promising efficacy and an acceptable safety profile for the treatment of patients with locally advanced or metastatic EGFR T790M-mutated NSCLC.
Clinical Trial Information:
NCT03502850.
Insights
Limertinib demonstrated significant efficacy in treating advanced EGFR T790M-mutated non-small cell lung cancer (NSCLC). This third-generation tyrosine kinase inhibitor showed a high objective response rate and manageable side effects in a phase 2b trial.
Area of Science:
- Oncology
- Pharmacology
- Clinical Trials
Background:
- Non-small cell lung cancer (NSCLC) remains a leading cause of cancer-related mortality worldwide.
- Epidermal growth factor receptor (EGFR) mutations, particularly the T790M resistance mutation, are key drivers in a subset of NSCLC patients.
- Third-generation EGFR tyrosine kinase inhibitors (TKIs) offer a targeted approach for patients with EGFR T790M-mutated NSCLC.
Purpose of the Study:
- To evaluate the efficacy and safety of limertinib (ASK120067), a novel third-generation EGFR TKI.
- To assess limertinib's effectiveness in patients with locally advanced or metastatic NSCLC harboring EGFR T790M mutations.
- To determine the objective response rate (ORR), progression-free survival (PFS), and safety profile of limertinib.
Main Methods:
- A single-arm, open-label, phase 2b clinical trial conducted across 62 hospitals in China.
- Enrolled patients with locally advanced or metastatic NSCLC and confirmed EGFR T790M mutations who progressed on prior EGFR TKIs.
- Patients received limertinib 160 mg orally twice daily; primary endpoint was ORR assessed by an independent review committee.
Main Results:
- A total of 301 patients were enrolled; the objective response rate (ORR) was 68.8% (95% CI: 63.2%-74.0%).
- The median progression-free survival (PFS) was 11.0 months (95% CI: 9.7-12.4), and the disease control rate was 92.4%.
- Treatment-related adverse events (TRAEs) were reported in 96.0% of patients, most commonly diarrhea (81.7%); Grade ≥3 TRAEs occurred in 34.6%.
Conclusions:
- Limertinib demonstrated promising efficacy, including a high ORR and meaningful PFS, in patients with EGFR T790M-mutated NSCLC.
- The safety profile of limertinib was found to be acceptable, with manageable adverse events.
- Limertinib represents a viable therapeutic option for patients with locally advanced or metastatic EGFR T790M-mutated NSCLC.
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