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Medline ® Abstract for Reference 21

of 'Systemic therapy for advanced non-small cell lung cancer with an activating mutation in the epidermal growth factor receptor'

LUX-Lung 4: a phase II trial of afatinib in patients with advanced non-small-cell lung cancer who progressed during prior treatment with erlotinib, gefitinib, or both.
Katakami N, Atagi S, Goto K, Hida T, Horai T, Inoue A, Ichinose Y, Koboyashi K, Takeda K, Kiura K, Nishio K, Seki Y, Ebisawa R, Shahidi M, Yamamoto N
J Clin Oncol. 2013;31(27):3335. Epub 2013 Jul 1.
PURPOSE: New molecular targeted agents are needed for patients with non-small-cell lung cancer (NSCLC) who progress while receiving erlotinib, gefitinib, or both. Afatinib, an oral irreversible ErbB family blocker, has preclinical activity in epidermal growth factor receptor (EGFR [ErbB1]) mutant models with EGFR-activating mutations, including T790M.
PATIENTS AND METHODS: This was a Japanese single-arm phase II trial conducted in patients with stage IIIB to IV pulmonary adenocarcinoma who progressed after≥12 weeks of prior erlotinib and/or gefitinib. Patients received afatinib 50 mg per day. The primary end point was objective response rate (complete response or partial response) by independent review. Secondary end points included progression-free survival (PFS), overall survival (OS), and safety.
RESULTS: Of 62 treated patients, 45 (72.6%) were EGFR mutation positive in their primary tumor according to local and/or central laboratory analyses. Fifty-one patients (82.3%) fulfilled the criteria of acquired resistance to erlotinib and/or gefitinib. Of 61 evaluable patients, five (8.2%; 95% CI, 2.7% to 18.1%) had a confirmed objective response rate (partial response). Median PFS was 4.4 months (95% CI, 2.8 to 4.6 months), and median OS was 19.0 months (95% CI, 14.9 months to not achieved). Two patients had acquired T790M mutations: L858R + T790M, and deletion in exon 19 + T790M; they had stable disease for 9 months and 1 month, respectively. The most common afatinib-related adverse events (AEs) were diarrhea (100%) and rash/acne (91.9%). Treatment-related AEs leading to afatinib discontinuation were experienced by 18 patients (29%), of whom four also had progressive disease.
CONCLUSION: Afatinib demonstrated modest but noteworthy efficacy in patients with NSCLC who had received third- or fourth-line treatment and who progressed while receiving erlotinib and/or gefitinib, including those with acquired resistance to erlotinib, gefitinib, or both.
Nobuyuki Katakami, Kobe City Medical Center General Hospital, Kobe; Shinji Atagi, National Hospital Organization Kinki-Chuo Chest Medical Center; Koji Takeda, Osaka City General Hospital; Kazuto Nishio, Kinki University, Osaka; Koichi Goto, National Cancer Center Hospital East, Chiba; Toyoaki Hida, Aichi Cancer Center Hospital, Nagoya; Takeshi Horai, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo; Akira Inoue, Tohoku University Hospital, Sendai; Yukito Ichinose, National Kyushu Cancer Center, Fukuoka; Kunihiko Koboyashi, Saitama International Medical Center, Saitama; Katsuyuki Kiura, Okayama University, Okayama; Yoko Seki and Ryuichi Ebisawa, Nippon Boehringer Ingelheim; Nobuyuki Yamamoto, Shizuoka Cancer Center, Shizuoka, Japan; and Mehdi Shahidi, Boehringer Ingelheim, Bracknell, United Kingdom.