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Barlesi F, Tomasini P, Karimi M, Michiels S, Raimbourg J, Daniel C, Janicot H, Madroszyk A, Audigier-Valette C, Quoix E, Mazieres J, Moro-Sibilot D, Dansin E, Molinier O, Morel H, Pichon E, Cortot A, Otto J, Chomy FO, Souquet PJ, Cloarec N, Giroux Leprieur E, Bieche I, Lacroix L, Boyault S, Attignon V, Soubeyran I, Morel A, Tran-Dien A, Jacquet A, Dall'Olio FG, Jimenez M, Soria JC, Besse B. Comprehensive genome profiling in patients with metastatic non-small cell lung cancer: the precision medicine phase 2 randomized SAFIR02-Lung trial. Clin Cancer Res 2022; 28:4018-4026. [PMID: 35802649 DOI: 10.1158/1078-0432.ccr-22-0371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/20/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Targeted therapies (TT) and immune checkpoint blockers (ICB) have revolutionized the approach to non-small cell lung cancer (NSCLC) treatment in the era of precision medicine. Their impact as switch maintenance therapy based on molecular characterization is unknown. EXPERIMENTAL DESIGN SAFIR02-Lung was an open-label, randomized, phase 2 trial, involving 33 centers in France. We investigated eight TT (substudy-1) and one ICB (substudy-2), compared to standard-of-care as a maintenance strategy in advanced EGFR, ALK wild-type (wt) NSCLC patients without progression after first line chemotherapy, based on high-throughput genome analysis. The primary outcome was progression-free survival (PFS). RESULTS Among the 175 patients randomized in substudy-1, 116 received TT (selumetinib, vistusertib, capivasertib, AZD4547, AZD8931, vandetanib, olaparib, savolitinib) and 59 standard-of-care. Median PFS was 2.7 months (95% CI 1.6-2.9) with TT vs. 2.7 months (1.6-4.1) with standard-of-care (HR 0.97, 0.7-1.36; p=0.87). There were no significant differences in PFS within any molecular subgroup. In substudy-2, 183 patients were randomized, 121 received durvalumab and 62 standard-of-care. Median PFS was 3.0 months (2.3-4.4) with durvalumab versus 3.0 months (2.0-5.1) with standard-of-care (HR=0.86; 0.62-1.20; p=0.38). Preplanned subgroup analysis showed an enhanced benefit with durvalumab in patients with PD-L1 Tumor Proportion Score (TPS) ≥ 1%, (n=29, HR=0.29; 0.11-0.75) as compared to PD-L1 <1% (n=31, HR=0.71, 0.31-1.60, interaction p= 0.036). CONCLUSIONS Molecular profiling can feasibly be implemented to guide treatment choice for the maintenance strategy in EGFR/ALK wt NSCLC; in the current study it did not lead to substantial treatment benefits beyond durvalumab for PD-L1 ≥ 1 patients.
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Affiliation(s)
- Fabrice Barlesi
- Aix Marseille University, CNRS, INSERM, CRCM, APHM, Marseille, France
| | - Pascale Tomasini
- Aix Marseille University, CNRS, INSERM, CRCM, APHM, Marseille, France
| | | | | | | | | | - Henri Janicot
- CHU - Hopital Gabriel Montpied, Clermont-Ferrand, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alain Morel
- Institut de Cancérologie de l'Ouest, Angers, France
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