한빛사논문
Prof Yi-Long Wu MD a, Prof Valentina Guarneri PhD b, Pei Jye Voon MD c, Boon Khaw Lim MRCP d, Prof Jin-Ji Yang MD a, Prof Marie Wislez PhD e,f, Prof Cheng Huang PhD g, Prof Chong Kin Liam MBBS [UM] h, Prof Julien Mazieres PhD i, Lye Mun Tho PhD j, Prof Hidetoshi Hayashi PhD k, Nguyen Viet Nhung PhD l, Puey Ling Chia PhD m, Prof Filippo de Marinis PhD n, Jo Raskin MD o, Prof Qinghua Zhou MD p, Giovanna Finocchiaro MD q, Anh Tuan Le PhD r, Prof Jialei Wang MD s, Christophe Dooms PhD t, Terufumi Kato PhD u, Ernest Nadal PhD v, Prof How Soon Hin MD w, Prof Egbert F Smit PhD x,y, Prof Martin Wermke MD z, Daniel Tan PhD aa, Masahiro Morise PhD ab, Aurora O'Brate PhD ac, Svenja Adrian MD ad, Boris M Pfeiffer MD ag, Christopher Stroh PhD ah, Dilafruz Juraeva PhD ai, Rainer Strotmann MD aj, Kosalaram Goteti MD ak, Karin Berghoff MD ae, Barbara Ellers-Lenz MSc af, Niki Karachaliou MD ad, Xiuning Le MD al, Prof Tae Min Kim MD am anfor the INSIGHT 2 investigators †
aGuangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
bDepartment of Surgery, Oncology and Gastroenterology, University of Padova, Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
cHospital Umum Sarawak, Kuching, Sarawak, Malaysia
dDepartment of Internal and Respiratory Medicine, Sunway Medical Centre, Selangor, Malaysia
eService de Pneumologie, Hôpital Cochin, Assistance Publique—Hôpitaux de Paris, Paris, France
fUniversité Paris Cité, Paris, France
gDepartment of Thoracic Oncology, Fujian Cancer Hospital, Fuzhou, China
hDepartment of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
iCHU de Toulouse, Université Paul Sabatier, Toulouse, France
jDepartment of Oncology, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
kDepartment of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
lNational Lung Hospital, University of Medicine and Pharmacy, Vietnam National University Hanoi, Viet Nam
mDepartment of Medical Oncology, Tan Tock Seng Hospital, Singapore
nDivision of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy
oDepartment of Pulmonology and Thoracic Oncology, Antwerp University Hospital (UZA), Edegem, Belgium
pLung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
qIRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
rCho Ray Hospital, Ho Chi Minh City, Viet Nam
sDepartment of Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
tDepartment of Respiratory Diseases and Respiratory Oncology Unit, University Hospitals Leuven, Leuven, Belgium
uDepartment of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
vDepartment of Medical Oncology, Catalan Institute of Oncology IDIBELL, L'Hospitalet, Barcelona, Spain
wHospital Tengku Ampuan Afzan, Pahang, Malaysia
xDepartment of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
yDepartment of Pulmonary Diseases, Leiden University Medical Center, Leiden, Netherlands
zTU Dresden, Faculty of Medicine Carl Gustav Carus, Department of Medicine I/NCT/UCC Early Clinical Unit, Dresden, Germany
aaDivision of Medical Oncology, National Cancer Centre Singapore, Singapore
abDepartment of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
acGlobal Medical Affairs, Merck, Darmstadt, Germany
adGlobal Clinical Development, Merck, Darmstadt, Germany
aeGlobal Patient Safety, Merck, Darmstadt, Germany
afDepartment of Biostatistics, Merck, Darmstadt, Germany
agGlobal Value Demonstration, Market Access and Pricing, Merck, Darmstadt, Germany
ahCompanion Diagnostics & Biomarker Strategy, Clinical Measurement Sciences, Merck, Darmstadt, Germany
aiData Sciences, Clinical Measurement Sciences, Merck, Darmstadt, Germany
ajQuantitative Pharmacology, Clinical Measurement Sciences, Merck, Darmstadt, Germany
akQuantitative Pharmacology, Clinical Measurement Sciences, EMD Serono Research & Development Institute, Billerica, MA, USA, an affiliate of Merck
alDepartment of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
amSeoul National University Cancer Research Institute, Seoul, South Korea
anDepartment of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
†INSIGHT 2 investigators are listed in the appendix (pp 2–3)
Correspondence to: Prof Yi-Long Wu, Prof Tae Min Kim
Abstract
Background
Patients with EGFR-mutated non-small-cell lung cancer (NSCLC) and MET amplification as a mechanism of resistance to first-line osimertinib have few treatment options. Here, we report the primary analysis of the phase 2 INSIGHT 2 study evaluating tepotinib, a highly selective MET inhibitor, combined with osimertinib in this population.
Methods
This open-label, phase 2 study was conducted at 179 academic centres and community clinics in 17 countries. Eligible patients were aged 18 years or older with an Eastern Cooperative Oncology Group performance status of 0 or 1 and advanced or metastatic EGFR-mutated NSCLC of any histology, with MET amplification by tissue biopsy fluorescence in-situ hybridisation (FISH; MET gene copy number of ≥5 or MET-to-CEP7 ratio of ≥2) or liquid biopsy next-generation sequencing (MET plasma gene copy number of ≥2·3), following progression on first-line osimertinib. Patients received oral tepotinib 500 mg plus oral osimertinib 80 mg once daily. The primary endpoint was independently assessed objective response in patients with MET amplification by central FISH treated with tepotinib plus osimertinib with at least 9 months of follow-up. Safety was analysed in patients who received at least one study drug dose. This study is registered with
ClinicalTrials.gov
,
NCT03940703
(enrolment complete).
Findings
Between Feb 13, 2020, and Nov 4, 2022, 128 patients (74 [58%] female, 54 [42%] male) were enrolled and initiated tepotinib plus osimertinib. The primary activity analysis population included 98 patients with MET amplification confirmed by central FISH, previous first-line osimertinib and at least 9 months of follow-up (median 12·7 months [IQR 9·9–20·3]). The confirmed objective response rate was 50·0% (95% CI 39·7–60·3; 49 of 98 patients). The most common treatment-related grade 3 or worse adverse events were peripheral oedema (six [5%] of 128 patients), decreased appetite (five [4%]), prolonged electrocardiogram QT interval (five [4%]), and pneumonitis (four [3%]). Serious treatment-related adverse events were reported in 16 (13%) patients. Deaths of four (3%) patients were assessed as potentially related to either trial drug by the investigator due to pneumonitis (two [2%] patients), decreased platelet count (one [1%]), respiratory failure (one [1%]), and dyspnoea (one [1%]); one death was attributed to both pneumonitis and dyspnoea.
Interpretation
Tepotinib plus osimertinib showed promising activity and acceptable safety in patients with EGFR-mutated NSCLC and MET amplification as a mechanism of resistance to first-line osimertinib, suggesting a potential chemotherapy-sparing oral targeted therapy option that should be further investigated.
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