FDA analysis of toxicity profiles of oral TKIs recently approved for non-small cell lung cancer based on receipt of prior immune checkpoint inhibitor therapy.

Authors

null

Yufan Liu

United States Food and Drug Administration, Silver Spring, MD

Yufan Liu , Elizabeth Duke , Nicole Lauren Drezner , Harpreet Singh , Paul Kluetz , Richard Pazdur , Erin A. Larkins

Organizations

United States Food and Drug Administration, Silver Spring, MD, Office of Oncologic Diseases, Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, Oncology Center of Excellence, Office of the Commissioner, U.S. Food and Drug Administration; Office of Oncologic Diseases, Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, Oncology Center of Excellence, U.S. Food and Drug Administration, Silver Spring, MD, Oncology Center of Excellence, U.S. Food and Drug Administration; Office of Oncologic Diseases, Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, Office of Oncologic Diseases, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD

Research Funding

No funding received
None.

Background: Immune checkpoint inhibitors (ICIs) targeting PD-(L)1 are standard front-line therapy for advanced non-small cell lung cancer (NSCLC). Molecularly targeted tyrosine kinase inhibitors (TKIs) are standard of care for subsets of oncogene-driven NSCLC. Published literature suggests the possibility of increased toxicity in patients who receive ICIs followed by EGFR or ALK TKI treatment. However, the toxicity profile in patients who receive ICIs followed by TKIs with other genomic targets has not been well described. Methods: Marketing applications for TKIs in patients with NSCLC submitted to the Office of Oncologic Diseases between Jan 2019 to Dec 2022 were reviewed. Datasets were analyzed for demographics, treatment-emergent adverse events (TEAE), and prior anti-cancer therapies for TKI-treated patients in the primary efficacy population. Drug classes for which < 5% of patients received prior ICI were excluded. Grade 3-4 TEAE, serious adverse events (SAE), discontinuation TEAE and TEAE of interest (hepatotoxicity, rash, and interstitial lung disease [ILD]) were summarized. Results: 9 applications were identified and 2 were excluded. The remaining applications involved TKIs targeting EGFR exon 20 insertion, KRAS G12C, MET exon 14 skipping, and RET fusion alterations. Analyses included 867 patients; 61% received prior ICI therapy. Patient characteristics and results of analyses are presented in the table. In our pooled analysis, the incidence of Grade 3-4 AEs, SAEs, and hepatotoxicity were slightly higher in the prior ICI group, while the incidence of discontinuation TEAE, ILD, and rash were similar between groups. Analysis for hepatotoxicity was limited to reported AEs (did not include analysis of laboratory data). Review of toxicity data across individual drug classes did not show major differences compared to the overall results. Conclusions: Our analysis of safety data for newer TKIs with varied genomic targets does not appear to show excessive toxicity in patients with NSCLC who received prior ICI compared to those who did not. In future clinical trials evaluating TKIs in this population, inclusion of patients who have received prior ICI therapy should be considered when appropriate.

TEAE summary for TKIs in patients with NSCLC based on receipt of prior ICI (N=867).

Prior ICI Therapy
(N = 528)
No Prior ICI Therapy
(N = 339)
Demographics
Sex54% F56% F
Age (years), median (range)63 (25-89)65 (23-90)
Race67% White
25% Asian
4% Black
48% White
46% Asian
2% Black
Ethnicity3% Hispanic or Latino1% Hispanic or Latino
Region60% U.S.
19% Asia
19% Europe
29% U.S.
44% Asia
25% Europe
Prior Radiotherapy59%45%
Drug Class35% RET
14% MET exon 14 skipping
42% KRAS G12C
9% EGFR ex20 ins
44% RET
33% MET exon 14 skipping
4% KRASG12C
19% EGFR ex20 ins
Toxicity
Grade 3 or 4 TEAE, %7163
SAEs, %5645
Discontinuation AE, %1212
Hepatotoxicity, %41
ILD, %46
Rash, %2625

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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 9119)

DOI

10.1200/JCO.2023.41.16_suppl.9119

Abstract #

9119

Poster Bd #

107

Abstract Disclosures