Patients with EGFR mutant (m) MET-altered NSCLC receiving tepotinib with an EGFR tyrosine kinase inhibitor (TKI): A case series.

Authors

Xiuning Le

Xiuning Le

Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX

Xiuning Le , Anna Eisert , Te-Chun Hsia , Nirmal Vivek Raut , Azura Ahmad , Oscar Siu Hong Chan , Charlotte De Bondt , David Farrugia , Patrizia Froesch , Maria González-Cao , Lizza Hendriks , Maximilian J. Hochmair , Julien Mazieres , Hazel O’Sullivan , Jens Samol , Anthonie J. van der Wekken , Tsung-Ying Yang , Kirti Joshi , Soetkin Vlassak , Gee-Chen Chang

Organizations

Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany, China Medical University Hospital, Taichung City, Taiwan, Bhaktivedanta Hospital And Research Centre and School of Consciouness, MIT WPU, Mumbai, India, Beacon Hospital, Selangor, Malaysia, Department of Clinical Oncology, Hong Kong Integrated Oncology Centre, Hong Kong, Hong Kong, Department of Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium, Gloucestershire Oncology Centre, Cheltenham General Hospital, Cheltenham, United Kingdom, Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland, Translational Cancer Research Unit, Instituto Oncológico Dr Rosell, Quirón Dexeus University Hospital, Barcelona, Spain, Department of Respiratory Medicine, Maastricht University Medical Centre, GROW School for Oncology and Reproduction, Maastricht, Netherlands, Department of Respiratory & Critical Care Medicine, Karl Landsteiner Institute of Lung Research & Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria, CHU de Toulouse, Pneumology Department, Paul Sabatier University, Toulouse, France, Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom, Department of Medical Oncology, Tan Tock Seng Hospital, Singapore, Asst Prof Johns Hopkins University, US, Asst Prof Lee Kong Chian/NTU, Singapore, Singapore, Department of Pulmonary Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands, Division of Chest Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Global Development Operations, the healthcare business of Merck KGaA, Darmstadt, Germany; ICON plc, Dublin, Ireland, Global Medical Affairs, Merck N.V.-S.A., Belgium, an affiliate of Merck KGaA, Darmstadt, Germany, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan

Research Funding

Pharmaceutical/Biotech Company
The healthcare business of Merck KGaA, Darmstadt, Germany

Background: Oncogenic activation of MET is a common mechanism of acquired resistance to EGFR TKIs in patients (pts) with EGFRm NSCLC, with MET amplification (amp) constituting the most frequent cause of bypass pathway activation. Currently, there are no approved targeted treatment options for these pts. Data from the Phase II INSIGHT (NCT01982955) and INSIGHT 2 (NCT03940703) studies indicate the combination of the selective MET TKI tepotinib plus an EGFR TKI has encouraging activity. We present a case series of pts with EGFRm MET-altered NSCLC receiving tepotinib plus an EGFR TKI outside of clinical trials. Methods: Access to tepotinib was provided to pts with EGFRm MET-altered NSCLC and resistance to EGFR TKIs through unsolicited compassionate use requests. All pts received tepotinib (500 mg [450 mg active moiety] once daily; first dose by Oct 2022) plus an EGFR TKI. Participating physicians provided case information up to January 2023. Results: 28 cases of pts with EGFRm NSCLC and MET alterations who received tepotinib plus an EGFR TKI were collated. 21 pts had METamp after EGFR TKI treatment, 5 had MET overexpression, and 2 had MET exon 14 skipping. Pts were aged 41–86 years, 15 were Asian, 13 were white, 19 were female, 8 had smoking history, and all had adenocarcinoma histology. METamp was detected by tissue biopsy in 17 pts, and liquid biopsy in 4 pts. Of 12 pts with METamp detected by FISH, gene copy number ranged from 5.3–33.4, and MET:CEP7 ratio from 0.7–15.1. EGFR TKIs received in combination with tepotinib were osimertinib (n = 21, 19 of whom received prior osimertinib), gefitinib (n = 6), dacomitinib (n = 1), afatinib (n = 1), with 1 pt received gefitinib followed by osimertinib. Tepotinib plus EGFR TKI was received by 9 pts as second-line, 9 as third-line, and 10 as fourth-or-later line. Median treatment duration was 8.8 months (range 1.3–20.6), with treatment ongoing in 13 pts (10 with current duration ≥10 months). Per the physician’s assessment, 25/28 pts (89%) had clinical benefit, 16 of whom (57%) were considered to have a partial response (PR). Clinical benefit was reported in 18/21 (86%) pts with METamp (12 PR, 57%), in 5/5 with MET overexpression (2 PR), and 2/2 with MET exon 14 skipping (2 PR). The most reported adverse event (AE) considered related to tepotinib was edema in 15 pts (most commonly peripheral edema). Grade 3 AEs related to tepotinib were reported in 5 pts (including Grade 3 edema in 2 pts), 1 of whom discontinued the combination due to Grade 3 pneumonitis. Conclusions: Tepotinib plus an EGFR TKI showed promising clinical activity in pts with MET-altered NSCLC who have progressed on a previous EGFR TKI, including those with several lines of prior treatment. Clinical benefit was observed irrespective of MET alteration type in this case series of pts treated outside of clinical trials, with a large proportion of patients continuing to benefit from ongoing treatment.

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Lung Cancer—Non-Small Cell Metastatic

Track

Lung Cancer

Sub Track

Metastatic Non–Small Cell Lung Cancer

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr 9070)

DOI

10.1200/JCO.2023.41.16_suppl.9070

Abstract #

9070

Poster Bd #

58

Abstract Disclosures