Helena A Yu1, Sarah B Goldberg2, Xiuning Le3, Zofia Piotrowska4, Jonathan W Goldman5, Adrianus J De Langen6, Isamu Okamoto7, Byoung Chul Cho8, Paul Smith9, Ilhem Mensi9, Helen Ambrose9, Silvija Kraljevic9, Julie Maidment10, Juliann Chmielecki11, Xiaocheng Li-Sucholeiki12, Gail Doughton9, Gargi Patel9, Phil Jewsbury9, Phil Szekeres9, Jonathan W Riess13. 1. Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: YuH@mskcc.org. 2. Yale School of Medicine, New Haven, CT, USA. 3. Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 4. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. 5. David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA. 6. Department of Thoracic Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands. 7. Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 8. Division of Medical Oncology, Yonsei Cancer Center, Seoul, Republic of Korea. 9. Early Oncology, Oncology R&D, AstraZeneca, Cambridge, UK. 10. Oncology Patient Safety, Oncology R&D, AstraZeneca, Cambridge, UK. 11. Translational Medicine, Oncology R&D, AstraZeneca, Boston, MA, USA. 12. Precision Medicine, Oncology R&D, AstraZeneca, Waltham, MA, USA. 13. UC Davis Comprehensive Cancer Center, Sacramento, CA, USA.
Abstract
INTRODUCTION: Osimertinib, a third-generation, irreversible, epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), selectively inhibits both EGFR-TKI sensitizing (EGFRm) and EGFR T790M resistance mutations and has demonstrated efficacy in non-small cell lung cancer (NSCLC) CNS metastases. Most patients with EGFRm NSCLC treated with osimertinib will eventually develop resistance. ORCHARD (NCT03944772) is a phase II study aiming to characterize first-line osimertinib resistance and identify post-progression treatments. METHODS: Adults aged ≥ 18 years (Japan ≥ 20 years), with EGFRm locally advanced/metastatic NSCLC will be allocated to one of three groups after first-line osimertinib progression, based on molecular profiling from a post-progression tumor biopsy. Group A will evaluate patients with protocol-determined biomarkers of resistance treated with novel osimertinib combination therapies, Group B will evaluate patients without a detectable protocol-determined biomarker treated with non-biomarker selected therapies that are chemotherapy- or EGFR-TKI-based, and Group C (observational) includes patients with histologically transformed disease, and/or a biomarker with an available therapy not investigated in ORCHARD. Group C patients will be treated as per local practice and followed to assess overall survival. The study's platform design allows for adaptability to include emerging treatments related to novel resistance mechanisms. The primary endpoint is confirmed objective response rate (investigator assessed). Other endpoints are progression-free survival, duration of response, overall survival, pharmacokinetics and safety. CONCLUSIONS: ORCHARD aims to characterize mechanisms of resistance to first-line osimertinib and explore treatments to overcome acquired resistance. The modular design allows for additional biomarker-directed cohorts and treatment options as understanding of osimertinib resistance mechanisms evolves.
INTRODUCTION: Osimertinib, a third-generation, irreversible, epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), selectively inhibits both EGFR-TKI sensitizing (EGFRm) and EGFR T790M resistance mutations and has demonstrated efficacy in non-small cell lung cancer (NSCLC) CNS metastases. Most patients with EGFRm NSCLC treated with osimertinib will eventually develop resistance. ORCHARD (NCT03944772) is a phase II study aiming to characterize first-line osimertinib resistance and identify post-progression treatments. METHODS: Adults aged ≥ 18 years (Japan ≥ 20 years), with EGFRm locally advanced/metastatic NSCLC will be allocated to one of three groups after first-line osimertinib progression, based on molecular profiling from a post-progression tumor biopsy. Group A will evaluate patients with protocol-determined biomarkers of resistance treated with novel osimertinib combination therapies, Group B will evaluate patients without a detectable protocol-determined biomarker treated with non-biomarker selected therapies that are chemotherapy- or EGFR-TKI-based, and Group C (observational) includes patients with histologically transformed disease, and/or a biomarker with an available therapy not investigated in ORCHARD. Group C patients will be treated as per local practice and followed to assess overall survival. The study's platform design allows for adaptability to include emerging treatments related to novel resistance mechanisms. The primary endpoint is confirmed objective response rate (investigator assessed). Other endpoints are progression-free survival, duration of response, overall survival, pharmacokinetics and safety. CONCLUSIONS: ORCHARD aims to characterize mechanisms of resistance to first-line osimertinib and explore treatments to overcome acquired resistance. The modular design allows for additional biomarker-directed cohorts and treatment options as understanding of osimertinib resistance mechanisms evolves.
Authors: Francesco Passiglia; Paolo Bironzo; Valentina Bertaglia; Angela Listì; Edoardo Garbo; Giorgio Vittorio Scagliotti Journal: Transl Lung Cancer Res Date: 2022-05