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Osimertinib Treatment in T790M-Positive NSCLC With CNS Metastases

By: Andrew Goldstein
Posted: Wednesday, September 19, 2018

Osimertinib demonstrated consistently superior central nervous system (CNS) efficacy compared with platinum/pemetrexed in patients with EGFR T790M–positive advanced non–small cell lung cancer (NSCLC) with CNS metastasis. These results from the AURA3 trial were reported by Yi-Long Wu, MD, of the Guangdong Lung Cancer Institute, Guangzhou, China, and colleagues in the Journal of Clinical Oncology. Osimertinib is a third-generation EGFR tyrosine kinase inhibitor (EGFR-TKI).

A total of 419 patients with T790M-positive NSCLC who previously received a first-line EGFR-TKI were randomized to 2:1 to receive osimertinib or platinum/pemetrexed treatment. A total of 116 patients had measurable and/or nonmeasurable CNS lesions, including 46 with measurable CNS lesions.

The overall response rate for patients with measurable lesions was 70% in the osimertinib arm, compared with 31% for the platinum/pemetrexed arm. For patients with measurable and nonmeasurable lesions, the overall response rates were 40% and 17% for osimertinib and platinum/pemetrexed, respectively. The median CNS duration of response for osimertinib and platinum/pemetrexed in those with measurable and/or nonmeasurable CNS lesions was 8.9 months and 5.7 months, respectively. Osimertinib also yielded a higher disease control rate than platinum/pemetrexed, 93% vs. 63%. Additionally, osimertinib had a 78% reduction in the risk of CNS disease progression, with a longer median CNS progression-free survival than the combination therapy (11.7 vs. 5.6 months).

“This is the first global phase III study showing a clear improvement in CNS [overall response rate] with an EGFR-TKI,” the investigators noted.



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