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May 29 - June 2, 2015 TIGER-X: Rociletinib Activity in EGFR T790M Mutant NSCLC CCO Independent Conference Highlights of the 2015 ASCO Annual Meeting* *CCO is an independent medical education company that provides state-of-the-art medical information to healthcare professionals through conference coverage and other educational programs. This program is supported by educational grants from AstraZeneca, Bayer, Bristol-Myers Squibb, Celgene Corporation, Genentech, Incyte, and Novartis.
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clinicaloptions.com/oncology TIGER-X: Rociletinib Activity in EGFR T790M Mutant NSCLC TIGER-X: Rociletinib (CO-1686) in Advanced NSCLC Rociletinib: third-generation oral, irreversible EGFR-TKI –Inhibits EGFR with activating mutations and T790M while sparing WT –Received FDA breakthrough therapy designation in May 2014 TIGER-X: phase I/II trial of rociletinib safety and efficacy in advanced EGFR mutation–positive NSCLC with acquired EGFR-TKI resistance –Previous results demonstrated activity in pts with or without T790M mutation –Current report focused on efficacy based on EGFR mutation analysis by genotyping plasma vs tumor tissue Sequist LV, et al. ASCO 2015. Abstract 8001. Sequist LV, et al. N Engl J Med. 2015;372:1700-1709.
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clinicaloptions.com/oncology TIGER-X: Rociletinib Activity in EGFR T790M Mutant NSCLC TIGER-X: Rociletinib in Previously Treated EGFR Mutation-Positive NSCLC Rociletinib 500 mg BID (n = 119) EGFR mutation– positive previously treated advanced or recurrent NSCLC with acquired resistance to prior EGFR TKI (N = 456) Key outcomes: safety and tolerability, PK profile, ORR Sequist LV, et al. ASCO 2015. Abstract 8001. Rociletinib 625 mg BID (n = 236) Rociletinib 750 mg BID (n = 95) Phase II expansion cohorts Upon progression on EGFR TKI T790M+ biopsy at entry Stable CNS metastases ok Phase I dose escalation Rociletinib BID 21-day cycles escalate to MTD
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clinicaloptions.com/oncology TIGER-X: Rociletinib Activity in EGFR T790M Mutant NSCLC TIGER-X: Pt Population Characteristic 500 mg (n = 119) 625 mg (n = 236) 750 mg (n = 95) 1000 mg (n = 6) Total (N = 456) Female, % 7164668366 Median age, yrs 6364626563 Enrolled in US, % 81848610084 ECOG PS 0, % 2528335028 Median prior treatment, % 1 prior TKI > 1 prior TKI Immediate prior TKI 3 56 44 74 2 55 45 84 2 59 41 91 4 33 67 2 56 44 82 History of CNS disease, %4042435041 Sequist LV, et al. ASCO 2015. Abstract 8001.
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clinicaloptions.com/oncology TIGER-X: Rociletinib Activity in EGFR T790M Mutant NSCLC TIGER-X: Tumor Response Across Rociletinib Dosing Sequist LV, et al. ASCO 2015. Abstract 8001. Reprinted with permission. 100 80 60 40 20 0 -20 -40 -60 -80 -100 SLD Change From Baseline (%) 500 mg BID HBr 625 mg BID HBr 750 mg BID HBr 1000 mg BID HBr Ongoing 500 mg625 mg750 mg1000 mgTotal N48114774243 ORR (%)6054467553 DCR (%)90848210085 Individual Patients
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clinicaloptions.com/oncology TIGER-X: Rociletinib Activity in EGFR T790M Mutant NSCLC TIGER-X: Safety Across Rociletinib Dosing Improved safety profile with 500 mg BID vs higher doses –Grade 3 QTc prolongation 2.5% –Discontinuation due to treatment-related AEs 2.5% vs 4% overall Once recognized, hyperglycemia manageable with oral agents AE (All Grades), % 500 mg (n = 119) 625 mg (n = 236) 750 mg (n = 95) 1000 mg (n = 6) Hyperglycemia Grade 3/4 35 17 45 24 59 36 67 33 Diarrhea 33403067 Nausea 19343750 QTc prolongation 13232650 Sequist LV, et al. ASCO 2015. Abstract 8001.
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clinicaloptions.com/oncology TIGER-X: Rociletinib Activity in EGFR T790M Mutant NSCLC TIGER-X: Plasma Testing for EGFR Mutations Plasma EGFR mutation assessed via digital PCR/flow cytometry assay shows good sensitivity and specificity vs standard tissue testing –81% agreement for T790M and 87% for activating mutations –Identified several T790M+ samples missed by tissue testing –T790M status confirmed in subsequent tissue testing –Plasma-based test overcomes limitations of tissue specimen availability Similar ORR in samples identified as T790M+ with plasma vs tissue –53% (78/147) vs 53% (85/160) Rociletinib also active in subset of pts confirmed T790M WT –ORR: 32% to 39% Sequist LV, et al. ASCO 2015. Abstract 8001.
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clinicaloptions.com/oncology TIGER-X: Rociletinib Activity in EGFR T790M Mutant NSCLC TIGER-X: Conclusions Rociletinib active and well tolerated in EGFR mutation–positive advanced NSCLC pts who have progressed after prior TKI therapy [1] –Recommended dose 500 mg BID due to lower toxicity vs higher doses –ORR 60%, disease control rate 90% at this dose T790M testing using plasma-based assay may provide viable alternative to tumor biopsy [1] –Authors suggest plasma assay may better reflect disease heterogeneity Additional TIGER trials under way to further explore rociletinib activity in EGFR-mutant NSCLC [2-4] 1. Sequist LV, et al. ASCO 2015. Abstract 8001. 2. ClinicalTrials.gov. NCT02186301. 3. ClinicalTrials.gov. NCT02147990. 4. ClinicalTrials.gov. NCT02322281.
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Go Online for More CCO Coverage of ASCO 2015! clinicaloptions.com/oncology Short slidesets of all the key data Additional CME-certified analyses with expert faculty commentary on all the key studies in: Gastrointestinal cancers Genitourinary cancer Hematologic malignancies Immunotherapy Lung cancer
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