David Planchard, Pasi A Jänne, James C-H Yang, Kunihiko Kobayashi, Natalia Valdiviezo, Yun Fan, Tae Min Kim, Manuel Leiva Gálvez, Kazumi Nishino, Bivas Biswas, Po Hao Feng, Virote Sriuranpong, Leona Koubkova, Gustavo Dix J Pinto, Carles Escriu, Tho Vinh Tran, Toshiaki Takahashi, Yeni Nerón, Ji-Youn Han, Alejandro Figueroa, Vicky Donachie, Anita Khullar, Azura Evans, Muna Albayaty, Chee Khoon Lee
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引用次数: 0
Abstract
Introduction: In the phase 3 FLAURA2 trial (NCT04035486), adding platinum-pemetrexed to first-line osimertinib significantly improved survival versus osimertinib monotherapy. We report a long-term longitudinal safety analysis, including incidence and temporal patterns of treatment-emergent adverse events (AEs).
Methods: Patients with EGFR-mutated advanced NSCLC were randomized to either osimertinib plus platinum-pemetrexed (for four cycles, followed by osimertinib plus pemetrexed maintenance), or osimertinib monotherapy. A post-hoc analysis of the combination arm, tailored to individual patients' exposure to each study treatment, was conducted to characterize the safety of three distinct treatment periods: induction (triple-combination therapy; n = 276), pemetrexed-maintenance (osimertinib-plus-pemetrexed; n = 201), and osimertinib-only (n = 206).
Results: In the combination arm, median (range) duration of each period was 2.8 (0.1-4.1), 12.4 (0.7-56.1), and 17.8 (0.4-56.8) months, respectively. Onset frequency of any-grade/grade ≥ 3 AEs causally related to treatment was highest during induction (93%/43%), decreasing progressively across the pemetrexed-maintenance (90%/25%) and osimertinib-only (58%/14%) periods. New AEs indicative of hematological, gastrointestinal, and skin/nail toxicity (mostly grade 1/2) were reported most frequently during induction, with reductions in frequency thereafter. Onset frequency of AEs indicative of renal toxicity was higher during pemetrexed maintenance (19%; all grade 1/2) than induction (7%; one grade 3). Rates of AEs leading to osimertinib discontinuation were low across periods (≤8%).
Conclusions: By characterizing safety according to individual treatment exposure, this novel analysis provides insight into the longitudinal safety of the FLAURA2 regimen. With prolonged treatment, grade ≥ 3 AE onset frequency progressively declined over successive treatment periods, while AE profiles remained consistent with the known safety profiles of the individual agents. Median durations of the pemetrexed-maintenance and osimertinib-only periods exceeded 12 and 17 months, respectively. This reinforces the favorable long-term benefit-risk profile of the FLAURA2 regimen.
期刊介绍：
Lung Cancer is an international publication covering the clinical, translational and basic science of malignancies of the lung and chest region.Original research articles, early reports, review articles, editorials and correspondence covering the prevention, epidemiology and etiology, basic biology, pathology, clinical assessment, surgery, chemotherapy, radiotherapy, combined treatment modalities, other treatment modalities and outcomes of lung cancer are welcome.
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