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Miura S, Koh Y, Azuma K, Yoshioka H, Koyama K, Teraoka S, Ishii H, Kibata K, Ozawa Y, Tokito T, Oyanagi J, Shimokawa T, Kurata T, Yamamoto N, Tanaka H. Afatinib plus osimertinib in the treatment of osimertinib-resistant non-small cell lung carcinoma: a phase I clinical trial. BMC Cancer 2023; 23:6. [PMID: 36597021 PMCID: PMC9808978 DOI: 10.1186/s12885-022-10467-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Conquering acquired resistance to osimertinib remains a major challenge in treating patients with epidermal growth factor receptor (EGFR) mutation-positive non-small-cell lung cancer (NSCLC). Thus, we aimed to determine the safety and efficacy of combination treatment with osimertinib and afatinib for patients with acquired resistance to osimertinib. METHODS This open-label phase I study was a feasibility study of the combination of afatinib and osimertinib for patients with advanced EGFR-positive NSCLC who had progressive disease after receiving osimertinib. The primary endpoint was to determine the maximum tolerated dose (MTD). We enrolled patients who received afatinib at three different dose levels (level 1, 20 mg; level 2, 30 mg; level 3, 40 mg) combined with osimertinib at a standard dose of 80 mg once per day. RESULTS Thirteen patients were enrolled in this study. The MTD was defined as 30 mg afatinib when combined with daily oral administration of osimertinib (80 mg). The most frequent adverse events were diarrhea (76.9%), anemia (76.9%), and rash (69.2%). Considering the toxicity profiles during all treatment periods, the recommended oral dose of afatinib was determined as 20 mg daily, with an osimertinib dose of 80 mg. For all evaluable patients (n = 12), the response rate was 7.7% and the disease-control rate was 46.2%. CONCLUSION Combination therapy with osimertinib and afatinib was tolerable; however, the synergistic effect of afatinib with osimertinib may be limited in osimertinib-resistant patients. TRIAL REGISTRATION Japan Registry of Clinical Trials ID: jRCTs051180008, registered date: 08/11/2018.
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Affiliation(s)
- Satoru Miura
- grid.416203.20000 0004 0377 8969Department of Internal Medicine, Niigata Cancer Center Hospital, 2-15-3 Kawagishicho, Chuo-ku, Niigata, Niigata 951-8566 Japan
| | - Yasuhiro Koh
- grid.412857.d0000 0004 1763 1087Internal Medicine III, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509 Japan ,grid.412857.d0000 0004 1763 1087Center for Biomedical Sciences, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509 Japan
| | - Koichi Azuma
- grid.410781.b0000 0001 0706 0776Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine 67 Asahi-machi, Kurume, 830-0011 Japan
| | - Hiroshige Yoshioka
- grid.410783.90000 0001 2172 5041Department of Thoracic Oncology, Kansai Medical University Hospital, 3-1, Shinmachi 2 Chome, Hirakata, Osaka, 573-1191 Japan
| | - Kenichi Koyama
- grid.416203.20000 0004 0377 8969Department of Internal Medicine, Niigata Cancer Center Hospital, 2-15-3 Kawagishicho, Chuo-ku, Niigata, Niigata 951-8566 Japan
| | - Shunsuke Teraoka
- grid.412857.d0000 0004 1763 1087Internal Medicine III, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509 Japan
| | - Hidenobu Ishii
- grid.410781.b0000 0001 0706 0776Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine 67 Asahi-machi, Kurume, 830-0011 Japan
| | - Kayoko Kibata
- grid.410783.90000 0001 2172 5041Department of Thoracic Oncology, Kansai Medical University Hospital, 3-1, Shinmachi 2 Chome, Hirakata, Osaka, 573-1191 Japan
| | - Yuichi Ozawa
- grid.412857.d0000 0004 1763 1087Internal Medicine III, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509 Japan
| | - Takaaki Tokito
- grid.410781.b0000 0001 0706 0776Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine 67 Asahi-machi, Kurume, 830-0011 Japan
| | - Jun Oyanagi
- grid.412857.d0000 0004 1763 1087Internal Medicine III, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509 Japan ,grid.412857.d0000 0004 1763 1087Center for Biomedical Sciences, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509 Japan
| | - Toshio Shimokawa
- grid.412857.d0000 0004 1763 1087Clinical Study Support Center, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509 Japan
| | - Takayasu Kurata
- grid.410783.90000 0001 2172 5041Department of Thoracic Oncology, Kansai Medical University Hospital, 3-1, Shinmachi 2 Chome, Hirakata, Osaka, 573-1191 Japan
| | - Nobuyuki Yamamoto
- grid.412857.d0000 0004 1763 1087Internal Medicine III, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509 Japan ,grid.412857.d0000 0004 1763 1087Center for Biomedical Sciences, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509 Japan
| | - Hiroshi Tanaka
- grid.416203.20000 0004 0377 8969Department of Internal Medicine, Niigata Cancer Center Hospital, 2-15-3 Kawagishicho, Chuo-ku, Niigata, Niigata 951-8566 Japan
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