MEchanisms of Resistance in EGFR Mutated Nonpretreated Advanced Lung Cancer Receiving OSimErtib

Summary

Osimertinib is an epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) that is selective for both EGFR-TKI sensitizing and T790M resistance mutations in patients with non-small-cell lung cancer.

The AURA 3 study (T790M-positive advanced non-small-cell lung cancer in progression after first-line EGFR-TKI therapy, shown that the median duration of progression-free survival was significantly longer with osimertinib than with platinum therapy plus pemetrexed (10.1 months vs. 4.4 months p\<0.001).

In addition, clinical data show that patients with mutated EGFR NSCLC receiving osimertinib in first line, presented an objective response rate of 77 % with a disease control rate of 98 % and a median PFS was 19.3 months.

Finally, The FLAURA study randomized phase 3 study clearly demonstrated the superiority of osimertinib compared with erlotinib or gefitinib in EGFR mutated nonpretreated NSCLC (median PFS of 18.9 months versus 10.2 months).

However, several issues remain unknown or debated :

* What are the mechanisms of resistance to osimertinib prescribed in first-line?
* What are the consequences of prolonged exposure to osimertinib on the expression of markers of response to immunotherapy?
* Is there an association between kinetic parameters of ctDNA (circulating tumor DNA) and prediction of response to osimertinib and/ or and prediction of therapeutic escape under osimertinib? In order to respond to all these questions, this phase II trial will be the first to systemically analyze the mechanisms of resistance to Osimertinib based on the analysis of biopsy, and collection of plasma from all patients during the course of treatment.

Conditions

• Non-small Cell Lung Cancer

Interventions

DRUG

TAGRISSO® 80mg (Osimertinib)

Oral administration of TAGRISSO® 80mg (Osimertinib) as a single daily dose until disease progression or unacceptable toxicity.

GENETIC

Tumor biopsies

Tumor biopsies performed at baseline and clinical progression will be processed (fixed) on site, and sent to Nantes University Hospital for analysis. The following analysis will be performed: 1. Analyses performed on a regular basis, in order to allow subsequent inclusion in other clinical trials : * C797S testing (digital PCR) * MET amplification (dPCR/FISH) * Histological examination of the tissue sample (to identify small cell transformation) * Expression of proteins by immunohistochemistry: PD-L1 (Ventana SP263 antibody); CD73 ; CD4; CD8. 2. At the end of inclusions, deep sequencing analysis to identify acquired mutations and copy number variations (amplifications).

GENETIC

ctDNA analysis

ctDNA analysis by Collection of plasma (two 10-ml Streck tubes) at each time point indicated in the trial. These samples will be sent at room temperature by courier to the central laboratory (Nantes University Hospital). There they will be centrifuged, and plasma will be frozen (-80°C). Analyses : * Detection of the EGFR activating mutation in plasma at baseline By dPCR (characterization of patients enrolled) * Detection of the EGFR activating mutation at d7 and m1 by dPCR (early detection of response to osimertinib) * Analysis of the plasma samples collected at clinical progression in order to identify acquired mechanisms of resistance by NGS (and comparison with analysis of the biopsies). * Kinetics studies of the alterations

Sponsors & Collaborators

• AstraZeneca

  collaborator INDUSTRY

• Nantes University Hospital

  lead OTHER

Principal Investigators

• Jaafar BENNOUNA, MD,PhD · Nantes University Hospital

Study Design

Allocation

NA

Purpose

TREATMENT

Masking

NONE

Model

SINGLE_GROUP

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2019-04-09

Primary Completion

2025-01-31

Completion

2025-01-31

Countries

• France

Study Locations