Modulation of Biomarker Expression by Osimertinib: Results of the Paired Tumor Biopsy Cohorts of the AURA Phase I Trial

Thress, Kenneth S.; Jacobs, Vivien N.; Angell, Helen K.; Yang, James Chih‐Hsin; Sequist, Lecia V.; Blackhall, Fiona; Su, Wu Chou; Schüler, Martin; Wolf, Jürgen; Gold, Kathryn A.; Cantarini, Mireille; Barrett, J. Carl

doi:10.1016/j.jtho.2017.07.011

Cited by 20 publications

(15 citation statements)

References 14 publications

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“…The overall T790M positive rate was 52.2% considering all testing methods, the ORR of T790M positive patients receiving osimertinib treatment was 60.9%. These data were similar compared with published data [ 7 , 9 – 11 ].…”

Section: Discussionsupporting

confidence: 91%

EGFR T790M detection and osimertinib treatment response evaluation by liquid biopsy in lung adenocarcinoma patients with acquired resistance to first generation EGFR tyrosine kinase inhibitors

Jia

Liu

et al. 2018

Diagn Pathol

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BackgroundLung adenocarcinoma with EGFR activating mutations will inevitably acquire resistance to first generation TKIs. Acquired EGFR T790M mutation causes about 50% of these resistance cases. Droplet digital PCR (ddPCR) and cobas enables quantification of T790M mutation. Whether these methods can predict clinical response of osimertinib treatment is unknown.MethodsTumor and blood samples from 69 stage IIIB-IV NSCLC patients acquired resistance to EGFR-TKI were collected. Cobas® Mutation Test v2 kit was used to detect EGFR mutations in FFPE or plasma samples. Plasma T790M mutation of both osimertinib naïve and treated patients were quantified by Droplet digital PCR (ddPCR).ResultsT790M mutation rate detected by FFPE tissue cobas, plasma ctDNA cobas and plasma ctDNA ddPCR test were 54.5, 21.3 and 30.4% respectively. The T790M positive rate was 52.2% considering all testing methods. The objective response rate (ORR) was 60.9% in 23 patients received osimertinib treatment. Quantification of T790M after treatment decreased to very low level, but no association was observed between clinical response and T790M mutation level decrease.ConclusionddPCR is more sensitive in plama ctDNA testing and should be performed even in tumor tissue T790M test negative cases. EGFR T790M mutation level is not associated with clinical response after osimertinib treatment.

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Section: Discussionsupporting

confidence: 91%

EGFR T790M detection and osimertinib treatment response evaluation by liquid biopsy in lung adenocarcinoma patients with acquired resistance to first generation EGFR tyrosine kinase inhibitors

Jia

Liu

et al. 2018

Diagn Pathol

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“…Finally, the role of the tumor microenvironment in modulating tumor evolution, is also gaining interest, particularly with respect to immune cell infiltration. Paired biopsies from the AURA1 trial of osimertinib, demonstrated the significant increased immune cell infiltrate (particularly CD8+ cells) associated with therapy [35]. Unfortunately, an early trial of combination osimertinib with durvalumab was suspended due to high rates of interstitial lung disease, much greater than would be expected with either agent alone [36].…”

Section: Therapeutic Targeting Of Persistencementioning

confidence: 99%

Third generation EGFR TKI landscape for metastatic EGFR mutant non-small cell lung cancer (NSCLC)

Tan

Teh

Lai

et al. 2019

Expert Review of Anticancer Therapy

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“…In the phase I AURA trial, 60 patients with the EGFR mutation (only 23% with the T790M mutation) received 80 or 160 mg/day osimertinib treatment. The ORR was 67% and 87%, and PFS was 22.1 and 19.3 months, respectively [ 39 ]. These results are more in line with the efficacy of erlotinib or afatinib in the first line, indicating that osimertinib can serve in the first-line treatment for NSCLC.…”

Section: Acquired Resistance and Corresponding Strategiesmentioning

confidence: 99%

Current Strategies for Treating NSCLC: From Biological Mechanisms to Clinical Treatment

Kwok

2020

Cancers

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The identification of specific epidermal growth factor receptor (EGFR)-activating mutations heralded a breakthrough in non-small-cell lung cancer (NSCLC) treatments, with the subsequent development of EGFR-tyrosine kinase inhibitor (TKIs) becoming the first-line therapy for patients harboring EGFR mutations. However, acquired resistance to EGFR-TKIs inevitably occurs in patients following initial TKI treatment, leading to disease progression. Various mechanisms are behind the acquired resistance, and mainly include (1) target gene modification, (2) alternative parallel pathway activation, (3) downstream pathway activation, and (4) histological/phenotypic transformation. Approaches to combat the acquired resistance have been investigated according to these mechanisms. Newer generations of TKIs have been developed to target the secondary/tertiary EGFR mutations in patients with acquired resistance. In addition, combination therapies have been developed as another promising strategy to overcome acquired resistance through the activation of other signaling pathways. Thus, in this review, we summarize the mechanisms for acquired resistance and focus on the potential corresponding therapeutic strategies for acquired resistance.

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Modulation of Biomarker Expression by Osimertinib: Results of the Paired Tumor Biopsy Cohorts of the AURA Phase I Trial

Abstract: Collection of paired biopsy samples was challenging because of rapid tumor regression after osimertinib treatment, highlighting the difficulties of performing on-study biopsies in patients treated with highly active drugs.

Cited by 20 publications

References 14 publications

EGFR T790M detection and osimertinib treatment response evaluation by liquid biopsy in lung adenocarcinoma patients with acquired resistance to first generation EGFR tyrosine kinase inhibitors

EGFR T790M detection and osimertinib treatment response evaluation by liquid biopsy in lung adenocarcinoma patients with acquired resistance to first generation EGFR tyrosine kinase inhibitors

Third generation EGFR TKI landscape for metastatic EGFR mutant non-small cell lung cancer (NSCLC)

Current Strategies for Treating NSCLC: From Biological Mechanisms to Clinical Treatment

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