AZD9291 in EGFR -Mutant Advanced Non-Small-Cell Lung Cancer Patients
Abstract
Non-small-cell lung cancer (NSCLC) patients whose tumors have an EGFR-activating mutation develop acquired resistance after a median of 9-11 months from the beginning of treatment with erlotinib, gefitinib and afatinib. T790M mutation is the cause of this resistance in approximately 60% of cases. AZD9291 is an oral, irreversible, mutant-selective EGF receptor (EGFR) tyrosine kinase inhibitor (TKI) developed to have potency against EGFR mutations, including T790M mutation, while sparing wild-type EGFR. A Phase I trial of AZD9291 in EGFR-mutant NSCLC patients, demonstrated high activity, essentially among T790M-mutant tumors, with a manageable tolerability profile. Ongoing Phase III trials are evaluating AZD9291 in EGFR-mutant patients as first-line treatment compared with erlotinib and gefitinib; and as second-line treatment compared with chemotherapy after progression on EGFR TKI in T790M-mutant tumors. Better identification of T790M-mutant tumors post EGFR TKI relapse and mechanisms of resistance to AZD9291 are the future challenges. This article reviews the emerging data regarding AZD9291 in the treatment of patients with advanced NSCLC.
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Compared to standard treatments of erlotinib or gefitinib, osimertinib has demonstrated significant benefits in median progression-free survival and median duration of response in NSCLC patients with EGFR exon deletion 19 or L858R mutations.
“Compared to the standard treatments of erlotinib or gefitin, osimertinib has demonstrated significant benefits in terms of both median progression-free survival and median duration of response in NSCLC patients with EGFR exon deletion 19 or L858R mutations.133”
From Recent advances in targeting the “undruggable” proteins: from drug discovery to clinical trials (2023) · cites this paper as [133]
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“In contrast, the response rates fell to 23% in patients without the T790M mutation [2].”
BackgroundMethodInfluentialTherapeutic value of EGFR inhibition in CRC and NSCLC: 15 years of clinical evidence
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BackgroundTargeted therapies for advanced non-small cell lung cancer
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Backgroundwritten on behalf of the AME Lung Cancer Collaborative Group, Jiang, T., Su, C., Ren, S., Cappuzzo, F., Rocco, G., Palmer, J. D., van Zandwijk, N., Blackhall, F. H., Le, X., et al. (2018) · Journal of Thoracic Disease · doi:10.21037/jtd.2018.07.61 · Cited by 53 · see citing works
“In the mouse model, osimertinib had a 10-fold greater distribution rate into the brain than gefitinib (42).”
BackgroundPatterns of progression on osimertinib in EGFR T790M positive NSCLC: A Swiss cohort study
Schmid, S., Klingbiel, D., Aeppli, S., Britschgi, C., Gautschi, O. P., Pless, M., Rothschild, S. I., Wannesson, L., Janthur, W.-D., Förbs, D., et al. (2019) · Lung Cancer · doi:10.1016/j.lungcan.2019.02.020 · Cited by 54 · see citing works
“EGFR mutations progressing on EGFR TKIs develop a T790 M resistance mutation [7].”
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PRODUCT MONOGRAPH INCLUDING PATIENT MEDICATION INFORMATION
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“Furthermore, C797S tertiary point mutation occurs in 40% of Osimertinib‐treated patients.(18) Figure 1 shows the EGFR activation and inhibition of related signaling pathways by drug binding.”
BackgroundOptimizing Osimertinib for NSCLC: Targeting Resistance and Exploring Combination Therapeutics
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“This may be one explanation for the decreased left ventricular ejection fraction, and heart failure in patients with NSCLC in clinical practice.”
BackgroundInfluentialAutophagy-related signaling pathways in non-small cell lung cancer
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“Osimertinib specifically binds irreversibly to EGFR by targeting the cysteine-797 residue in the ATP-binding site via covalent bond formation, potently inhibiting its phosphorylation.(20) However, C797S mutant EGFR cannot form a covalent bond with osimertinib because serine fails to form a covalent bond under physiolo…”
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“reported, and patients expressed a high degree of satisfaction with osimertinib therapy, supporting clinical data that indicate a manageable tolerability profile [20].”
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13-Oxyingenol-dodecanoate inhibits the growth of non-small cell lung cancer cells by targeting ULK1
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“The results from an EGFRmutant BM xenograft mouse model indicated osimertinib distribution into the brain was 10-fold higher than gefitinib and resulted in a marked shrinkage of brain lesions.(20) Preliminary results presented at the 2016 ASCO meeting also showed an impressive response for osimertinib in patients with…”
ResultConsensus on precision medicine for metastatic cancers: A report from the MAP
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Modern Approaches to Anti-EGFR Therapy
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Cytoskeletal remodeling via CAMSAP3 downregulation drives resistance to osimertinib in NSCLC cells
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- Authors
- Remon, J., & Planchard, D.
- Affiliations
- Gustave Roussy, Medical Oncology Department, Villejuif, France
- Institut Gustave Roussy (FR)
- ORCID
- Planchard, David
- Venue
- Future Oncology
- Publisher
- Informa UK Limited
- Published
- 2015-10-09
- Volume
- 11
- Issue
- 22
- Pages
- 3069-3081
- ISSN
- 1479-6694 (ISSN-L)
- 1744-8301
- OpenAlex
- W1937437568
- Cited by
- 33
- References
- 68
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 3 · 2023: 2 · 2021: 2 · 2020: 2 · 2019: 3 · 2018: 4 · 2017: 4 · 2016: 6 · 2015: 1
- FWCI
- 0.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Future Oncology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
- Health Sciences › Medicine › Oncology › HER2/EGFR in Cancer Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Keywords
- osimertinib, EGFR-mutant non-small cell lung cancer, T790M mutation, EGFR tyrosine kinase inhibitors, acquired drug resistance, erlotinib, gefitinib, afatinib, irreversible tyrosine kinase inhibitor, first-line therapy, second-line therapy, resistance mechanisms
- MeSH terms
- Acrylamides, Aniline Compounds, Animals, Brain Neoplasms, Carcinoma, Non-Small-Cell Lung, Drug Evaluation, Preclinical, Humans, Indoles, Lung Neoplasms, Mutation, Neoplasm Recurrence, Local, Neoplasm Staging, Pyrimidines, Treatment Outcome, Clinical Trials, Phase I as Topic, Clinical Trials, Phase II as Topic, Clinical Trials, Phase III as Topic, Disease Progression, Drug Resistance, Neoplasm, Retreatment, Protein Kinase Inhibitors, ErbB Receptors
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