Treatment of EGFR mutant advanced NSCLC Raffaele Califano Department of Medical Oncology The Christie and University Hospital of South Manchester, Manchester, UK
Outline Data on first-line Overcoming T790M mutation Conclusion
First-line treatment NSCLC Histological sub-type EGFR/ALK/PD-L1 status
NSCLC with EGFR activating mutation
EGFR-TKIs in pretreated NSCLC patients ISEL BR.21 Thatcher et al, Lancet 2005; Shepherd et al, NEJM 2005,
EGFR activating mutations Lynch et al, NEJM 2004
EGFR activating mutations Sharma et al, Nat Rev Cancer 2007
Gefitinib
IPASS Trial Never or light ex-smoker with adenocarcinoma PS 0 2 Stage IIIB or IV chemo-naive NSCLC N=1217 R A N D O M I Z E Gefitinib (250 mg/day) Carboplatin/Paclitaxel up to 6 cycles Mok et al, NEJM 2009
PFS in ITT population Probability of PFS 1.0 0.8 0.6 Gefitinib Carboplatin / paclitaxel 5.7 vs 5.8 months 0.4 0.2 0.0 0 4 8 12 16 20 24 Months At risk : Gefitinib 609 363 212 76 24 5 0 Carboplatin / paclitaxel 608 412 118 22 3 1 0
IPASS - Biomarker analysis N=1217 (100%) N=1038 biomarke r consent (85%) N=683 provided samples (56%) N=437 evaluabl e for EGFR mutation (36%)
Probability of progression-free survival Probability of progression-free survival PFS in EGFR M+ and M- EGFR mutation positive EGFR mutation negative 1.0 Gefitinib (n=132) Carboplatin / paclitaxel (n=129) 1.0 Gefitinib (n=91) Carboplatin / paclitaxel (n=85) 0.8 HR (95% CI) = 0.48 (0.36, 0.64) p<0.0001 0.8 HR (95% CI) = 2.85 (2.05, 3.98) p<0.0001 0.6 9.5 vs 6.3 months 0.6 0.4 0.4 0.2 0.2 At risk : Gefitinib C / P 0.0 0 4 8 12 16 20 24 Months 132 108 71 31 11 3 0 129 103 37 7 2 1 0 0.0 0 4 8 12 16 20 24 Months 91 21 4 2 1 0 0 85 58 14 1 0 0 0 Treatment by subgroup interaction test, p<0.0001 ITT population Cox analysis with covariates
Overall Survival Probability of survival 1.0 0.8 0.6 0.4 Gefitinib Carboplatin / paclitaxel 18.8 vs 17.4 months HR 0.90; P = 0.109 0.2 0.0 0 4 8 12 16 20 28 Months At risk : 24 Gefitinib 609 514 423 239 118 38 0 0 Carboplatin / 608 524 401 212 104 32 1 0 paclitaxel
ORR in EGFR M+ and WT
% patients with sustained clinically relevant improvement Quality of life p=0.0148 p<0.0001 p=0.3037
Gefitinib in Asian Studies EGFR M+ Study N Regimen RR (%) PFS HR NEJ002 230 G 73.7 10.8 C/P 30.7 5.4 0.30 WJTOG 3405 177 G 62.1 9.2 C/D 32.2 6.3 0.48 Maemondo et al, NEJM 2010; Mitsudomi et al, Lancet Oncol 2010
Erlotinib
OPTIMAL study design Chemonaïve patients with stage IIIB/IV NSCLC PS 0 2 EGFR Act Mut+ n=165 R (1:1) Erlotinib Gemcitabine/Carb oplatin x 4 cycles PD Completed enrollment in <12 months Zhou et al, Lancet Oncol 2011
PFS probability OPTIMAL - PFS 1.0 0.8 Erlotinib 13.1 months G/C 4.6 months 0.6 0.4 HR=0.16 (95% CI: 0.10 0.26) Log-rank p<0.0001 0.2 0 0 5 10 15 20 25 30 Time (months) Patients at risk Erlotinib 82 70 51 29 8 2 0 G/C 72 26 4 1 0 0 0
Overall Response Rate
Patients with clinically relevant improvement during the study (%) Quality of Life
EURTAC Chemonaїve Stage IIIB/IV NSCLC EGFR exon 19 deletion or exon 21 L858R mutation ECOG PS 0 2 (n=174) R (1:1) Erlotinib Platinum doublet x 4 cycles PD Rosell et al, Lancet Oncol 2012
Study profile 1227 patients screened 174 patients randomized by 26 Jan 2011 Turn-around time:4.5days 1227 Screened 224 M+ (17.6%) 50 pts not eligible 86 erlotinib 88 chemotherapy 52 PFS events 59 PFS events 94 remain in OS follow-up Completed enrollment in 4 years
PFS probability Progression Free Survival 1.0 0.8 Erlotinib (n=86) Chemotherapy (n=87) 0.6 0.4 0.2 5.2 9.7 HR=0.37 (0.25 0.54) Log-rank p<0.0001 0 0 3 6 9 12 15 18 21 24 27 30 33 Time (months)
Response Rate Erlotinib (n=86) n (%) Chemotherapy (n=87) n (%) Complete response 2 (2) 0 (0) Partial response 48 (56) 13 (15) Objective response rate 50 (58) 13 (15) Stable disease 18 (21) 44 (51) Disease control rate 68 (79) 57 (66)
OS probability Overall Survival 1.0 0.8 0.6 0.4 0.2 0 Erlotinib Chemotherapy HR=0.80 (0.47 1.37) Log-rank p=0.4170 0 3 6 9 12 15 18 21 24 27 30 33 36 39 Time (months)
Afatinib
Afatinib Irreversible ErbB blockade
LUX-LUNG 3 Stage IIIB/IV Adeno PS 0 1 Chemotherapy-naïve EGFR mutant (n=345) R 2:1 Afatinib 40mg OD (n=230) Pemetrexed/Cisplatin q21d up to 6 cycles (n=115) Primary endpoint: PFS (IRR) Sequist LV, et al, JCO 2013
LUX-LUNG 6 Stage IIIB/IV PS 0 1 Chemotherapy-naïve EGFR mutant (n=364) Primary endpoint: PFS (IRR) Only East Asia R 2:1 Afatinib 40mg OD (n=242) Cisplatin/Gemcitabine up to 6 cycles (n=122) Wu Y-L, et al, Lancet Oncol 2014
LUX-Lung 3 and 6 Efficacy LUX-LUNG 3 LUX-LUNG 6 Afatinib n=230 Cis/pem n=115 Afatinib n=242 Cis/gem n=122 ORR (%) 56.1 22.5 66.9 23 Median PFS (mos) 11.1 6.9 11.0 5.6 HR (95% CIl) 0.58 (0.43 0.78) p=0.0004 0.28 (0.20-0.39) P<0.0001
Adverse Events Afatinib (n=229) Cis/Pem (n=111) All Gr (%) Gr 3 (%) Gr 4 (%) All Gr (%) Gr 3 (%) Gr 4 (%) Diarrhea 218 (95.2) 33 (14.4) 0 17 (15.3) 0 0 Rash/acne 204 (89.1) 37 (16.2) 0 7 (6.3) 0 0 Stomatitis/mucositis 165 (72.1) 19 (8.3) 1 (0.4) 17 (15.3) 1 (0.9) 0 Paronychia 130 (56.8) 26 (11.4) 0 0 0 0 Dry skin 67 (29.3) 1 (0.4) 0 2 (1.8) 0 0 Nausea 41 (17.9) 2 (0.9) 0 73 (65.8) 4 (3.6) 0 Decreased appetite 47 (20.5) 7 (3.1) 0 59 (53.2) 3 (2.7) 0 Fatigue 40 (17.5) 3 (1.3) 0 52 (46.8) 14 (12.6) 0 Vomiting 39 (17.0) 7 (3.1) 0 47 (42.3) 3 (2.7) 0 Neutropenia 2 (0.9) 1 (0.4) 0 35 (31.5) 17 (15.3) 3 (2.7) Anemia 7 (3.1) 1 (0.4) 0 31 (27.9) 5 (4.5) 2 (1.8)
Other Endpoints Better tolerated Symptom control Afatinib arm Global health status/qol
LUX-Lung 3 and 6: Updated OS LUX-Lung 3 (n=345) LUX-Lung 6 (n=364) Recruitment period Aug 09 Feb 11 Apr 10 Nov 11 Primary PFS analysis Feb 12 (221 events) Oct 12 (221 events) Required maturity of OS At least 209 events At least 237 events OS analysis Dec 13 (213 events; 61.7%) Jan 14 (246 events; 67.6%) Median OS follow-up 41 months 33 months OS result, overall population 28.2 vs 28.2 months HR=0.88, p=0.3850 23.1 vs 23.5 months HR=0.93, p=0.6137 Yang, et al, Lancet Oncol 2015
Trials of EGFR-TKIs vs CT in M+ Study N Median PFS (mos) Median OS (mos) TKI Chemo HR (95 % CI) TKI Chemo IPASS 261 9.5 6.3 0.48 (0.36-0.64) 21.6 21.9 First Signal 42 8.0 6.3 0.54 (0.26-1.10) 27.2 25.6 NEJ002 194 10.4 5.5 0.35 (0.25-0.50) 27.7 26.6 WJTOG 172 9.2 6.3 0.48 (0.33-0.71) 36 39 OPTIMAL 154 13.7 4.6 0.16 (0.10-0.26) 22.6 28.8 EURTAC 174 10.4 5.1 0.34 (0.25 0.54) 19.3 19.5 LUX-LUNG 3 345 11.1 6.9 0.58 (0.43-0.78) 28.2 28.2 LUX-LUNG 6 364 11.1 5.6 0.28 (0.20-0.39 23.1 23.5
Lux-Lung 7 Stage IIIB/IV adenocarcinoma EGFR mutation (Del19 and/or L858R) No prior treatment for advanced/ metastatic disease ECOG PS 0/1 N= 319 1:1 Afatinib 40 mg OD Stratified by Mutation type (Del19/L858R) Brain metastases (present/absent) Gefitinib 250 mg OD Treatment beyond progression allowed Primary endpoints: PFS (IRR), TTF, OS Paz-Ares et al, Ann Oncol 2017
Estimated PFS probability Progression-free Survival 1.0 0.8 0.6 Afatinib (n=160) Gefitinib (n=159) Median PFS (months) 11.0 10.9 HR (95% CI) 0.74 (0.57 0.95) p value 0.0178 No. of patients Afatinib Gefitinib 0.4 p=0.0176 27% p=0.0184 0.2 18% 15% 0 8% 0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 Time (months) 160 142 112 94 67 47 34 27 21 13 6 3 1 0 0 159 132 106 83 52 22 14 9 7 5 3 3 1 1 0
Probability of being on-treatment Time to treatment failure 1.0 0.8 0.6 0.4 Afatinib (n=160) Gefitinib (n=159) Median TTF (months) 13.7 11.5 HR (95% CI) 0.75 (0.60-0.94) p value 0.0136 0.2 No. of patients Afatinib Gefitinib 0 0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 Time (months) 160 148 133 113 91 68 56 48 40 25 18 9 5 0 0 159 144 120 103 74 59 43 30 21 11 6 6 2 2 0
ORR and DOR p=0.002 73% 56% Median DoR (mos) Afatinib (n=112) Gefitinib (n=89) 10.1 8.3 95% CI (8.2 11.1) (7.3 10.2) Afatinib n=112/160 Gefitinib n=89/159
Estimated OS probability Overall Survival 1.0 0.8 Afatinib (n=160) Gefitinib (n=159) 0.6 0.4 Median, months HR (95% CI) p-value 27.9 24.5 0.86 (0.66 1.12) 0.2580 0.2 0 0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 Time (months)
Efficacy in De1 19 and L858R Del 19 L858R Afatinib Gefitinib Afatinib Gefitinib Median PFS (months) 12.7 11.0 Median PFS (months) 10.9 10.8 HR (95% CI) p value 0.76 (0.55 1.06) 0.1071 HR (95% CI) p value 0.71 (0.47 1.06) 0.0856 Median OS, (months) 30.7 26.4 Median OS, (months) 25.0 21.2 HR (95% CI) p-value 0.83 (0.58 1.17) 0.2841 HR (95% CI) p-value 0.91 (0.62 1.36) 0.6585
Adverse Events Events, % Afatinib (n=160) Gefitinib (n=159) Any AE 98.8 100.0 Drug-related AEs 97.5 96.2 AEs leading to dose reduction* 41.9 1.9* Drug-related AEs leading to discontinuation 6.3 6.3 Serious AEs 44.4 37.1 Drug-related serious AEs 10.6 4.4 Drug-related fatal AE - 0.6 *No dose reductions foreseen for gefitinib according to prescribing information Including four patients with drug-related ILD (no drug-related ILD on afatinib) One patient died of hepatic failure
Mechanisms of resistance Blakely et al, Cancer Discovery 2012
Tackling T790M resistance mutation
Osirmetinib wt EGFR EGFRm T790M TAGRISSO Potential to Inhibition of T790M Inhibition of EGFRm Low activity on wt EGFR Overcome resistance Continue targeting sensitizing mutations Lower incidence of rash and diarrhoea Cross DAE, et al. Cancer Discovery 2014
Phase I Osirmetinib Clinical development AURA Ph I/II Patients with T790M-positive ansclc whose disease has progressed following either one prior therapy with an EGFR-TKI or following treatment with both EGFR-TKI and other anticancer therapy Rolling six design AURA2 Ph II Patients with confirmed EGFRm locally advanced or metastatic NSCLC who have progressed following prior therapy with an approved EGFR-TKI Escalation Cohort 1 20 mg Cohort 2 40 mg Negative Cohort 3 80 mg n=63 Negative Cohort 4 160 mg Cohort 5 240 mg Positive Positive Positive Positive Positive Negative Central T790M mutation testing* of biopsy sample collected following confirmed disease progression Expansion First-line Biopsy Tablet Cytology First-line Biopsy T790M positive T790M negative AURA Phase II Extension (n=201) Osimertinib 80 mg QD Pooled Phase II AURA2 (n=210) Osimertinib 80 mg QD Not eligible for enrollment Janne PA et al, NEJM 2015; Goss et al, Lancet Oncol 2016
Probability of PFS Probability of PFS Progression-Free Survival 1.0 0.9 AURA Ph I 1.0 0.9 AURA pooled Ph II 0.8 0.8 0.7 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0.0 Number of patients at risk: Osimertinib 80 mg 0 3 6 9 12 15 18 Month 63 55 48 36 25 20 21 24 27 15 9 5 1 0.6 0.5 0.4 0.3 0.2 0.1 0.0 0 3 6 9 12 15 18 21 24 27 Number of patients at risk: Month Osimertinib 80 mg 441 332 271 205 161 38 0 AURA Ph I (80 mg) AURA pooled Ph II N=63 (80 mg) N=411 Median PFS *, months (95% CI) 9.7 (8.3, 13.6) 11.0 (9.6, 12.4) Remaining alive and progression-free, % (95% CI) 12 months 18 months 24 months 41 (29, 53) 29 (18, 41) 17 (8, 30) 48 (42, 53) NC NC Yang JCH, et al. ELCC 2016
Adverse Events AE category, all causality, n (%) AURA Ph I (80 mg) N=63* AURA pooled Ph II (80 mg) N=411 Any AE 62 (98) 406 (99) Any AE Grade 3 29 (46) 149 (36) Any AE leading to death 1 (2) 14 (3) Any AE leading to dose interruption 16 (25) 87 (21) Any AE leading to dose reduction 1 (2) 16 (4) Any AE leading to discontinuation 3 (5) 26 (6) Any serious AE 18 (29) 107 (26) AE category, causally-related Any AE 57 (91) 364 (89) Any AE Grade 3 11 (18) 56 (14) Any AE leading to discontinuation 0 16 (4) Any serious AE 3 (5) 23 (6) Yang JCH, et al. ELCC 2016
Drug-related AEs Ph I exp Causally-related AEs occurring in 15% of patients overall, n (%) Rash (grouped terms) AURA Ph I (80 mg) N=63* Grade 1 Grade 2 Grade 3 Any grade 21 (33) 2 (3) 0 23 (37) Diarrhoea 16 (25) 3 (5) 1 (2) 22 (35) Paronychia (grouped terms) Dry skin (grouped terms) 11 (18) 6 (10) 1 (2) 18 (29) 11 (18) 3 (5) 0 14 (22) Fatigue 9 (14) 0 0 10 (16) Select AEs ILD (grouped terms) 0 0 1 (2) 1 (2) Hyperglycaemia 0 0 0 0 QT prolongation 0 0 1 (2) 1 (2) Yang JCH, et al. ELCC 2016
Drug-related AEs pooled Ph2 Causally-related AEs occurring in 15% of patients overall, n (%) AURA pooled Ph II (80 mg) N=411* Grade 1 Grade 2 Grade 3 Any grade Rash (grouped terms) 146 (36) 18 (4) 3 (<1) 167 (41) Diarrhoea 138 (34) 17 (4) 2 (<1) 157 (38) Dry skin (grouped terms) Paronychia (grouped terms) 116 (28) 9 (2) 0 125 (30) 88 (21) 30 (7) 0 118 (29) Select AEs ILD (grouped terms) 4 (1) 0 8 (2) 12 (3) Hyperglycaemia 0 1 (<1) 0 1 (<1) QT prolongation 7 (2) 3 (<1) 4 (1) 14 (3) Yang JCH, et al. ELCC 2016
AURA3 study Key eligibility criteria Locally advanced or metastatic NSCLC Evidence of disease progression following first-line EGFR-TKI therapy Documented EGFRm and central confirmation of tumour EGFR T790M mutation after firstline EGFR-TKI treatment PS 0 or 1 No more than one prior line of treatment for advanced NSCLC Stable asymptomatic CNS metastases allowed R 2:1 Osimertinib 80 mg OD (n=279) Platinumpemetrexed +/- maintenance pemetrexed (n=140) Endpoints Primary: PFS by investigator assessment (RECISTv1.1) Secondary and exploratory: OS ORR DoR DCR Tumour shrinkage BICR-assessed PFS PROs Safety and tolerability Optional crossover: Protocol amendment allowed patients on chemotherapy to begin post- BICR confirmed progression open-label osimertinib treatment Mok TS et al, NEJM 2016
Probability of Progression-free Survival Progression-free Survival (investigator) 1.0 0.8 0.6 Osimertinib (n=279) Platinum-pemetrexed (n=140) Median PFS (95% Cl) 10.1 (8.3 12.3) 4.4 (4.2 5.6) HR for disease progression or death, 0.30 (95% Cl, 0.23 0.41) P<0.001 0.4 0.2 0 0 3 6 9 12 15 18 Months
Response Rate Osimertinib (n=279) Platinumpemetrexed (n=140) ORR, % (95% CI) 71% (65, 76) 31% (24, 40) Odds ratio* (95% CI) Complete response, n (%) Partial response, n (%) Stable disease 6 weeks, n (%) Progression, n (%) RECIST progression, n (%) Death Not evaluable, n (%) 5.39 (3.47, 8.48); P<0.001 4 (1) 193 (69) 63 (23) 18 (6) 15 (5) 3 (1) 1 (<1) 2 (1) 42 (30) 60 (43) 26 (19) 22 (16) 4 (3) 10 (7) DCR, % (95% CI) 93 (90, 96) 74 (66, 81) Odds ratio* (95% CI) Median time to response, weeks (95% CI) 4.76 (2.64, 8.84); P<0.001 6.1 (NC, NC) 6.4 (6.3, 7.0) Median DoR #, months (95% CI) 9.7 (8.3, 11.6) 4.1 (3.0, 5.6)
Safety AE category*, n (%) Osimertinib (n=279) Platinum-pemetrexed (n=136) Any AE 273 (98) 135 (99) Any AE Grade 3 63 (23) 64 (47) Any AE leading to death 4 (1) 1 (1) Any serious AE 50 (18) 35 (26) Any AE leading to discontinuation 19 (7) 14 (10) AE category, possibly causally related, n (%) Any AE 231 (83) 121 (89) Any AE Grade 3 16 (6) 46 (34) Any AE leading to death 1 (<1) 1 (1) Any serious AE 8 (3) 17 (13) Any AE leading to discontinuation 10 (4) 12 (9)
Adverse Events N (%) 15% cut-off Osimertinib (n=279) Platinum-pemetrexed (n=136) Any grade Grade 3 Any grade Grade 3 Any AE 273 (98) 63 (23) 135 (99) 64 (47) Diarrhoea 113 (41) 3 (1) 15 (11) 2 (1) Rash 94 (34) 2 (1) 8 (6) 0 Dry skin 65 (23) 0 6 (4) 0 Paronychia 61 (22) 0 2 (1) 0 Decreased appetite 50 (18) 3 (1) 49 (36) 4 (3) Cough 46 (16) 0 19 (14) 0 Nausea 45 (16) 2 (1) 67 (49) 5 (4) Fatigue 44 (16) 3 (1) 38 (28) 1 (1) Stomatitis 41 (15) 0 21 (15) 2 (1) Constipation 39 (14) 0 47 (35) 0 Vomiting 31 (11) 1 (<1) 27 (20) 3 (2) Thrombocytopaenia 28 (10) 1 (<1) 27 (20) 10 (7) Neutropaenia 22 (8) 4 (1) 31 (23) 16 (12) Leukopenia 22 (8) 0 20 (15) 5 (4) Anaemia 21 (8) 2 (1) 41 (30) 16 (12) Asthenia 20 (7) 3 (1) 20 (15) 6 (4) Select adverse events Interstitial lung disease 10 (4) 1 (<1) 1 (1) 1 (1) QT prolongation 10 (4) 1 (<1) 1 (1) 0
Take Home Message Screen for EGFR mutations! EGFR-TKIs are standard of care in EGFR M+ Look for T790M resistance mutation
Backup Slides
Aura 3 EGFR Plasma ctdna Patients with tissue sample available at screening (n=756) Plasma ctdna test results, n Tissue T790M positive (n=399) Tissue Exon 19 deletion positive (n=427) Tissue L858R positive (n=253) Plasma positive 184 273 139 Plasma negative 175 60 67 No plasma test / invalid 37 / 3 91 / 3 47 / 0 Percent agreement using tissue test as reference, % (95% CI) * Positive percent agreement (sensitivity) Negative percent agreement (specificity) 51 (46, 57) 82 (77, 86) 68 (61, 74) 77 (71, 83) 98 (96, 100) 99 (98, 100) Overall concordance 61 (57, 65) 89 (86, 91) 88 (85, 90)
Probability of progression-free survival Probability of progression-free survival AURA3: Efficacy in pts with plasma and tumour tissue T790M+ status Tumour T790M-positive (ITT) PFS HR (95% CI) Median PFS, months (95% CI) Osimertinib Platinumpemetrexed Platinumpemetrexed 0.30 (0.23, 0.41)*, p<0.001 10.1 (8.3, 12.3) 4.4 (4.2, 5.6) ORR, % (95% CI) 71 (65, 76) 31 (24, 40) Plasma T790M-positive status Osimertinib PFS HR (95% CI) 0.42 (0.29, 0.61) Median PFS, months (95% CI) 8.2 (6.8, 9.7) 4.2 (4.1, 5.1) ORR, % (95% CI) 77 (68, 84) 39 (27, 53) 1.0 0.8 Osimertinib (n=279) Platinum-pemetrexed (n=140) 1.0 0.8 Osimertinib (n=116) Platinum-pemetrexed (n=56) 0.6 0.6 0.4 0.4 0.2 0.2 0 0 3 6 9 12 15 18 Months 0 0 3 6 9 12 15 18 Months
Estimated OS probability Estimated OS probability LUX-Lung 3 and 6: OS in common mutations 1.0 0.8 Median, months HR (95%CI), p-value LUX-Lung 3 Afatinib n=203 Pem/Cis n=104 31.6 28.2 0.78 (0.58 1.06), p=0.1090 1.0 0.8 Median, months HR (95%CI), p-value LUX-Lung 6 Afatinib n=216 Gem/Cis n=108 23.6 23.5 0.83 (0.62 1.09), p=0.1756 0.6 0.6 0.4 0.4 0.2 0.2 0 0 0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 Time (months) Time (months)
Estimated OS probability Estimated OS probability OS in Del19 subgroup 1.0 Median, months HR (95%CI), p-value LUX-Lung 3 Afatinib n=112 Pem/Cis n=57 33.3 21.1 0.54 (0.36 0.79), p=0.0015 1.0 Median, months HR (95%CI), p-value LUX-Lung 6 Afatinib n=124 Gem/Cis n=62 31.4 18.4 0.64 (0.44 0.94), p=0.0229 0.8 0.8 0.6 0.6 0.4 0.4 0.2 0.2 0 0 0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 Time (months) Time (months)
Estimated OS probability Combined OS analysis: common mutations (n=631) 1.0 0.8 0.6 Afatinib n=419 Chemo n=212 Median, months 27.3 24.3 HR (95%CI), p-value 0.81 (0.66 0.99), p=0.0374 0.4 0.2 0 0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 Time (months)
Estimated OS probability Estimated OS probability Combined OS analysis: mutation categories 1.0 0.8 Median, months HR (95%CI), p-value Del19 Afatinib n=236 Chemo n=119 31.7 20.7 0.59 (0.45 0.77), p=0.0001 1.0 0.8 Median, months HR (95%CI), p-value L858R Afatinib n=183 Chemo n=93 22.1 26.9 1.25 (0.92 1.71), p=0.1600 0.6 0.6 0.4 0.4 0.2 0.2 0 0 0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 Time (months) Time (months)
Treatment at progression LUX-Lung 3 LUX-Lung 6 Afatinib (n=203) Pem/Cis (n=104) Afatinib (n=216) Gem/Cis (n=108) Discontinued treatment, n (%) 184 (100) 104 (100) 194 (100) 108 (100) Subsequent systemic therapy, n (%) 144 (78) 88 (85) 123 (63) 70 (65) Chemotherapy, n (%) 131 (71) 49 (47) 114 (59) 29 (27) EGFR TKI therapy, n (%) 81 (44) 78 (75) 50 (26) 61 (56) Erlotinib Gefitinib Afatinib AZD9291 Dacomitinib Icotinib EGFR TKI combinations 61 (33) 28 (15) 2 (1) 2 (1) 5 (3) 46 (42) 44 (42) 7 (7) 1 (1) 1 (1) 9 (9) 21 (11) 19 (10) 11 (6) 5 (3) 22 (20) 39 (36) 3 (3) 3 (3) Other systemic therapy, n (%) 5 (3) 2 (2) 3 (2) 4 (4) Radiotherapy, n (%) 32 (17) 21 (20) 4 (2) 0 (0)