51
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Meador CB, Jin H, de Stanchina E, Nebhan CA, Pirazzoli V, Wang L, Lu P, Vuong H, Hutchinson KE, Jia P, Chen X, Eisenberg R, Ladanyi M, Politi K, Zhao Z, Lovly CM, Cross DAE, Pao W. Optimizing the sequence of anti-EGFR-targeted therapy in EGFR-mutant lung cancer. Mol Cancer Ther 2014; 14:542-52. [PMID: 25477325 DOI: 10.1158/1535-7163.mct-14-0723] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Metastatic EGFR-mutant lung cancers are sensitive to the first- and second-generation EGFR tyrosine kinase inhibitors (TKIs) gefitinib, erlotinib, and afatinib, but resistance develops. Acquired resistance to gefitinib or erlotinib occurs most commonly (>50%) via the emergence of a second-site EGFR mutation, T790M. Two strategies to overcome T790M-mediated resistance are dual inhibition of EGFR with afatinib plus the anti-EGFR antibody cetuximab (A+C), or mutant-specific EGFR inhibition with AZD9291. A+C and AZD9291 are now also being tested as first-line therapies, but whether these therapies will extend progression-free survival or induce more aggressive forms of resistance in this setting remains unknown. We modeled resistance to multiple generations of anti-EGFR therapies preclinically to understand the effects of sequential treatment with anti-EGFR agents on drug resistance and determine the optimal order of treatment. Using a panel of erlotinib/afatinib-resistant cells, including a novel patient-derived cell line (VP-2), we found that AZD9291 was more potent than A+C at inhibiting cell growth and EGFR signaling in this setting. Four of four xenograft-derived A+C-resistant cell lines displayed in vitro and in vivo sensitivity to AZD9291, but four of four AZD9291-resistant cell lines demonstrated cross-resistance to A+C. Addition of cetuximab to AZD9291 did not confer additive benefit in any preclinical disease setting. This work, emphasizing a mechanistic understanding of the effects of therapies on tumor evolution, provides a framework for future clinical trials testing different treatment sequences. This paradigm is applicable to other tumor types in which multiple generations of inhibitors are now available.
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Affiliation(s)
- Catherine B Meador
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Hailing Jin
- Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Elisa de Stanchina
- Antitumor Assessment Core, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Caroline A Nebhan
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Valentina Pirazzoli
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut. Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Lu Wang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Pengcheng Lu
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Huy Vuong
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Katherine E Hutchinson
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Peilin Jia
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Xi Chen
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Rosana Eisenberg
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Marc Ladanyi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katerina Politi
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut. Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut. Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Zhongming Zhao
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tennessee. Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee. Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Christine M Lovly
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tennessee. Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Darren A E Cross
- AstraZeneca Oncology Innovative Medicines, Alderley Park, Macclesfield, Cheshire, United Kingdom
| | - William Pao
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tennessee. Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee. Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
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55
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Finlay MRV, Anderton M, Ashton S, Ballard P, Bethel PA, Box MR, Bradbury RH, Brown SJ, Butterworth S, Campbell A, Chorley C, Colclough N, Cross DAE, Currie GS, Grist M, Hassall L, Hill GB, James D, James M, Kemmitt P, Klinowska T, Lamont G, Lamont SG, Martin N, McFarland HL, Mellor MJ, Orme JP, Perkins D, Perkins P, Richmond G, Smith P, Ward RA, Waring MJ, Whittaker D, Wells S, Wrigley GL. Discovery of a Potent and Selective EGFR Inhibitor (AZD9291) of Both Sensitizing and T790M Resistance Mutations That Spares the Wild Type Form of the Receptor. J Med Chem 2014; 57:8249-67. [DOI: 10.1021/jm500973a] [Citation(s) in RCA: 381] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- M. Raymond V. Finlay
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Mark Anderton
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Susan Ashton
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Peter Ballard
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Paul A. Bethel
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Matthew R. Box
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Robert H. Bradbury
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Simon J. Brown
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Sam Butterworth
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Andrew Campbell
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Christopher Chorley
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Nicola Colclough
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Darren A. E. Cross
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Gordon S. Currie
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Matthew Grist
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Lorraine Hassall
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - George B. Hill
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Daniel James
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Michael James
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Paul Kemmitt
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Teresa Klinowska
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Gillian Lamont
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Scott G. Lamont
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Nathaniel Martin
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Heather L. McFarland
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Martine J. Mellor
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Jonathon P. Orme
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - David Perkins
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Paula Perkins
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Graham Richmond
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Peter Smith
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Richard A. Ward
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Michael J. Waring
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - David Whittaker
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Stuart Wells
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
| | - Gail L. Wrigley
- Oncology Innovative Medicines, ‡Drug Safety and
Metabolism, §Global Medicines Development, and ∥Discovery Sciences, AstraZeneca, Mereside,
Alderley Park, Macclesfield, Cheshire SK10 4TG, U.K
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58
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Landi L, Tiseo M, Chiari R, Ricciardi S, Rossi E, Galetta D, Novello S, Milella M, D'Incecco A, Minuti G, Tibaldi C, Salvini J, Facchinetti F, Haspinger ER, Cortinovis D, Santo A, Banna G, Catino A, GiajLevra M, Crinò L, de Marinis F, Cappuzzo F. Activity of the EGFR-HER2 dual inhibitor afatinib in EGFR-mutant lung cancer patients with acquired resistance to reversible EGFR tyrosine kinase inhibitors. Clin Lung Cancer 2014; 15:411-417.e4. [PMID: 25242668 DOI: 10.1016/j.cllc.2014.07.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/01/2014] [Accepted: 07/09/2014] [Indexed: 01/26/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the efficacy of afatinib in EGFR-mutant metastatic NSCLC patients with acquired resistance to erlotinib or gefitinib. MATERIALS AND METHODS We retrospectively analyzed the outcome of patients with EGFR-mutant advanced NSCLC treated with afatinib after failure of chemotherapy and EGFR TKIs. RESULTS A total of 96 individuals were included in the study. According to EGFR status, most patients (n = 63; 65.6%) harbored a deletion in exon 19, and de novo T790M mutation was detected in 2 cases (T790M and exon 19). Twenty-four (25%) patients underwent repeated biopsy immediately before starting afatinib and secondary T790M was detected in 8 (33%) samples. Among the 86 patients evaluable for efficacy, response rate was 11.6%, with a median progression free-survival (PFS) and overall survival (OS) of 3.9 and 7.3 months, respectively. No significant difference in PFS and OS was observed according to type of last therapy received before afatinib, type of EGFR mutation or adherence to Jackman criteria, and patients benefiting from afatinib therapy had longer PFS and OS (P < .001). Outcome results for repeated biopsy patients were similar to the whole population, with no evidence of response in T790M-positive patients. All patients were evaluable for toxicity, and 81% experienced an AE of any grade, with grade 3 to 4 AEs, mainly diarrhea and skin toxicity, occurring in 19 (20%) patients. CONCLUSION Our results showed that afatinib has only modest efficacy in a real life population of EGFR mutant NSCLC patients with acquired resistance to erlotinib or gefitinib.
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Affiliation(s)
- Lorenza Landi
- Department of MedicalOncology, Istituto Toscano Tumori, Livorno, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Rita Chiari
- Division of Medical Oncology, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Serena Ricciardi
- High Specialization Hospitals, Oncological Pulmonary First Unit, Rome, Italy
| | - Elisa Rossi
- Fondazione Ricerca Traslazionale, FoRT, Rome, Italy
| | - Domenico Galetta
- Division Of Medical Oncology, Istituto Tumori "Giovanni Paolo II", IRCCS, Bari, Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, Azienda Ospedaliero-Universitaria, San Luigi Gonzaga, Turin, Italy
| | - Michele Milella
- Division of Medical Oncology A, Regina Elena National Cancer Institute, Rome, Italy
| | - Armida D'Incecco
- Department of MedicalOncology, Istituto Toscano Tumori, Livorno, Italy
| | - Gabriele Minuti
- Department of MedicalOncology, Istituto Toscano Tumori, Livorno, Italy
| | - Carmelo Tibaldi
- Department of MedicalOncology, Istituto Toscano Tumori, Livorno, Italy
| | - Jessica Salvini
- Department of MedicalOncology, Istituto Toscano Tumori, Livorno, Italy
| | | | - Eva Regina Haspinger
- Division of Medical Oncology, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy
| | - Diego Cortinovis
- Division of Medical Oncology, Ospedale San Gerardo, Monza, Italy
| | - Antonio Santo
- Division of Medical Oncology, Azienda Ospedaliera Universitaria Integrate, Verona, Italy
| | - Giuseppe Banna
- Medical Oncology Service, Cannizzaro Hospital, Catania, Italy
| | - Annamaria Catino
- Division Of Medical Oncology, Istituto Tumori "Giovanni Paolo II", IRCCS, Bari, Italy
| | - Matteo GiajLevra
- Department of Oncology, University of Turin, Azienda Ospedaliero-Universitaria, San Luigi Gonzaga, Turin, Italy
| | - Lucio Crinò
- Division of Medical Oncology, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Filippo de Marinis
- Division of Thoracic Oncology, Istituto Europeo di Oncologia, Milano, Italy
| | - Federico Cappuzzo
- Department of MedicalOncology, Istituto Toscano Tumori, Livorno, Italy.
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