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Robert M Lorence



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    P1.01 - Advanced NSCLC (Not CME Accredited Session) (ID 933)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.01-11 - Named Patient Use Program for Afatinib in Advanced NSCLC with Progression on Prior Therapy: Experience from Asian Centers (ID 12968)

      16:45 - 18:00  |  Author(s): Robert M Lorence

      • Abstract
      • Slides

      Background

      A global named patient use (NPU) program for afatinib in patients with advanced/metastatic NSCLC who had progressed during prior therapy was conducted between May 2010 and January 2016 (Cappuzzo F et al, Future Oncol 2018). Here we describe treatment outcomes for patients at Asian centers.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Eligible patients had progressed after clinical benefit on prior erlotinib/gefitinib and/or had an activating EGFR/HER2 mutation, had exhausted all other treatments, and were ineligible for afatinib trials. Patients received afatinib (starting dose:30-50 mg/day). Dose modifications were allowed as tolerated. Time to treatment failure (TTF) was calculated from treatment initiation to discontinuation. Adverse event (AE) reporting was mandatory.

      4c3880bb027f159e801041b1021e88e8 Result

      Data were collected from 2242 NSCLC patients across 10 Asian countries. Patients were heavily pretreated, 62% received ≥2 prior chemotherapy lines, and for most, afatinib was 4th-line therapy; almost all had received erlotinib/gefitinib (Table 1). 97% of patients with known tumor status were EGFR mutation-positive (m+). Median TTF was 7.6 months overall, and 7.2 months in patients with EGFR m+ tumors (Table 1). TTF was >12 months in patients with EGFR exon20 insertions and Her2 mutations. ORR was numerically higher in patients with exon20 insertions and G719X/L861Q/S761I mutations than other subgroups (Table 1). Disease control rate was 78% overall. The most frequently reported AEs were rash and diarrhea; no new/unexpected safety signals were identified.

      Table 1. Named patient use (NPU) program for afatinib in advanced/metastatic NSCLC: results from Asian centers
      Total number of patients 2242
      Age; years, median 61
      Female/male; % 60/40
      Any prior treatment; n (%) 2223/2242 (99.2)
      Prior erlotinib and/or gefitinib; n (%) 2202/2223 (99.1)
      Prior erlotinib only; n (%) 866/2202 (39)
      Prior gefitinib only; n (%) 927/2202 (42)
      Prior lines of chemotherapy ≥3, 32%; ≥2, 62%; 1, 23%; 0, 15%
      Prior lines of systemic therapy ≥4, 37%; ≥3, 65%; 2, 21%; 1, 14%; 0, 0%
      EGFR m+; n (%) 1240/1281 (97)
      Specified EGFR mutation; n (%) 1101/1240 (89)
      TTF; months* n ORR, % n
      All patients with data available 7.6 1550 24.4 431
      EGFR m+ 7.2 834 27.7 267
      EGFR mutation specified 6.5 740 - -
      Common mutations (Del19 or L858R) 6.4 692 27.4 230
      Uncommon mutations (all) 8.0 84 30.3 33
      T790M 6.0 34 21.1 19
      G719X, L861Q, or S761I 7.8 28 42.9 7
      Exon 20 insertion 18.0 25 42.9 7
      Her2 m+ 12.2 12 14.2 7
      p.A775 G776insYVMA 12.4 7 25.0 4

      *median

      m+ve, mutation-positive; ORR, objective response rate;

      TTF, time to treatment failure

      8eea62084ca7e541d918e823422bd82e Conclusion

      This analysis from Asian countries in the afatinib NPU program revealed clinically meaningful TTF/ORR in this heavily pre-treated and refractory advanced NSCLC patient population, including activity in common and uncommon EGFR mutations. TTF was numerically longer in patients with uncommon mutations (particularly EGFR exon20 insertions) and HER2 mutations than in those with common EGFR mutations. The safety profile of afatinib was consistent with non-Asian centers.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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