P86.12 Cardiac Safety Assessment of Lazertinib in Patients with EGFR Mutation-Positive Advanced Non-Small Cell Lung Cancer

Overview of the multifaceted resistances toward EGFR-TKIs and new chemotherapeutic strategies in non-small cell lung cancer

The role of epidermal growth factor receptor (EGFR) in non-small cell lung cancer (NSCLC) has been vastly studied over the last decade. This has led to the rapid development of many generations of EGFR tyrosine kinase inhibitors (EGFR-TKIs). However, patients treated with third-generation TKIs (osimertinib, avitinib and rociletinib) targeting the EGFR T790M mutation have shown emerging resistances and relapses. Therefore, further molecular understanding of NSCLC mutations, bypass signalling, tumour microenvironment and the existence of cancer stem cells to overcome such resistances is warranted. This will pave the way for designing novel and effective chemotherapies to improve patients' overall survival. In this review, we provide an overview of the multifaceted mechanism of resistances towards EGFR-TKIs, as well as the challenges and perspectives that should be addressed in strategising chemotherapeutic treatments to overcome the ever evolving and adaptive nature of NSCLC.

A Phase 1/2 Study of Lazertinib 240 mg in Patients with Advanced EGFR T790M-Positive Non-Small Cell Lung Cancer After Prior EGFR Tyrosine Kinase Inhibitors

INTRODUCTION

This integrated analysis of a phase 1/2 study (NCT03046992) assessed the efficacy and safety of lazertinib, a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), in patients with advanced EGFR T790M-positive non-small cell lung cancer (NSCLC) after prior EGFR TKI therapy.

METHODS

Adults with EGFR mutation-positive NSCLC that progressed after prior EGFR-directed TKIs received once-daily oral lazertinib 240 mg continuously until disease progression. Prior TKIs to treat T790M-positive NSCLC were prohibited. Primary endpoints were safety and objective response rate (ORR). Secondary endpoints included progression-free survival, overall survival, and intracranial ORR.

RESULTS

Seventy-eight patients received lazertinib 240 mg at 17 centers in South Korea. Among patients with T790M-positive tumors at baseline (n=76), 1 (1.3%) had a complete response and 41 (53.9%) had partial responses, giving an ORR of 55.3% (95% CI, 44.1-66.4). Median progression-free survival was 11.1 months (95% CI, 5.5-16.4). Median overall survival was not reached (median follow-up 22.0 months). In patients with measurable intracranial lesions (n=7), 1 (14.3%) had a complete intracranial response and 5 (71.4%) had partial responses, giving an intracranial ORR of 85.7% (95% CI, 59.8-100.0%). The most common treatment-emergent adverse events were rash (37.2%), pruritus (34.6%), and paresthesia (33.3%); most were mild to moderate in severity. Serious drug-related adverse events occurred in 3 patients (gastritis, pneumonia, pneumonitis). The major mechanism of resistance was EGFR T790M loss.

CONCLUSIONS

Lazertinib 240 mg/day has a manageable safety profile with durable antitumor efficacy, including brain metastases, in patients with advanced T790M-positive NSCLC after prior EGFR TKI therapy.

Lazertinib: First Approval

Lazertinib (LECLAZA^®) is an oral, third-generation, epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) being developed by Yuhan and Janssen Biotech for the treatment of non-small cell lung cancer (NSCLC). It is a brain-penetrant, irreversible EGFR-TKI that targets the T790M mutation and activating EGFR mutations Ex19del and L858R, while sparing wild type-EGFR. In January 2021, lazertinib received its first approval for the treatment of patients with EGFR T790M mutation-positive locally advanced or metastatic NSCLC who have previously received EGFR-TKI therapy. This article summarizes the milestones in the development of lazertinib leading to this first approval.