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Jänne PA, Baik C, Su WC, Johnson ML, Hayashi H, Nishio M, Kim DW, Koczywas M, Gold KA, Steuer CE, Murakami H, Yang JCH, Kim SW, Vigliotti M, Shi R, Qi Z, Qiu Y, Zhao L, Sternberg D, Yu C, Yu HA. Efficacy and Safety of Patritumab Deruxtecan (HER3-DXd) in EGFR Inhibitor-Resistant, EGFR-Mutated Non-Small Cell Lung Cancer. Cancer Discov 2022; 12:74-89. [PMID: 34548309 PMCID: PMC9401524 DOI: 10.1158/2159-8290.cd-21-0715] [Citation(s) in RCA: 119] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/16/2021] [Accepted: 09/15/2021] [Indexed: 01/12/2023]
Abstract
Receptor tyrosine-protein kinase ERBB3 (HER3) is expressed in most EGFR-mutated lung cancers but is not a known mechanism of resistance to EGFR inhibitors. HER3-DXd is an antibody-drug conjugate consisting of a HER3 antibody attached to a topoisomerase I inhibitor payload via a tetrapeptide-based cleavable linker. This phase I, dose escalation/expansion study included patients with locally advanced or metastatic EGFR-mutated non-small cell lung cancer (NSCLC) with prior EGFR tyrosine kinase inhibitor (TKI) therapy. Among 57 patients receiving HER3-DXd 5.6 mg/kg intravenously once every 3 weeks, the confirmed objective response rate by blinded independent central review (Response Evaluation Criteria in Solid Tumors v1.1) was 39% [95% confidence interval (CI), 26.0-52.4], and median progression-free survival was 8.2 (95% CI, 4.4-8.3) months. Responses were observed in patients with known and unknown EGFR TKI resistance mechanisms. Clinical activity was observed across a broad range of HER3 membrane expression. The most common grade ≥3 treatment-emergent adverse events were hematologic toxicities. HER3-DXd has clinical activity in EGFR TKI-resistant cancers independent of resistance mechanisms, providing an approach to treat a broad range of drug-resistant cancers. SIGNIFICANCE: In metastatic EGFR-mutated NSCLC, after disease progression on EGFR TKI therapy, treatment approaches include genotype-directed therapy targeting a known resistance mechanism or chemotherapy. HER3-DXd demonstrated clinical activity spanning known and unknown EGFR TKI resistance mechanisms. HER3-DXd could present a future treatment option agnostic to the EGFR TKI resistance mechanism.See related commentary by Lim et al., p. 16.This article is highlighted in the In This Issue feature, p. 1.
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Affiliation(s)
- Pasi A. Jänne
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Corresponding Author: Pasi A. Jänne, Dana-Farber Cancer Institute, 450 Brookline Avenue, LC4114, Boston, MA 02215. Phone: 617-632-6036; Fax: 617-582-7683; E-mail:
| | | | - Wu-Chou Su
- National Cheng Kung University Hospital, Tainan, Taiwan
| | - Melissa L. Johnson
- Sarah Cannon Research Institute/Tennessee Oncology, PLCC, Nashville, Tennessee
| | | | - Makoto Nishio
- The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Japan
| | - Dong-Wan Kim
- Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | | | | | - Conor E. Steuer
- Winship Cancer Institute of Emory University, Atlanta, Georgia
| | | | | | - Sang-We Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | - Rong Shi
- Daiichi Sankyo, Inc., Basking Ridge, New Jersey
| | - Zhenhao Qi
- Daiichi Sankyo, Inc., Basking Ridge, New Jersey
| | - Yang Qiu
- Daiichi Sankyo, Inc., Basking Ridge, New Jersey
| | - Lihui Zhao
- Daiichi Sankyo, Inc., Basking Ridge, New Jersey
| | | | - Channing Yu
- Daiichi Sankyo, Inc., Basking Ridge, New Jersey
| | - Helena A. Yu
- Memorial Sloan Kettering Cancer Center, New York, New York
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