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Ref Type Journal Article
PMID (30206164)
Authors Peters S, Stahel R, Bubendorf L, Bonomi P, Villegas A, Kowalski DM, Baik CS, Isla D, Carpeno JC, Garrido P, Rittmeyer A, Tiseo M, Meyenberg C, de Haas S, Lam LH, Lu MW, Stinchcombe TE
Title Trastuzumab Emtansine (T-DM1) in Patients with Previously Treated HER2-Overexpressing Metastatic Non-Small Cell Lung Cancer: Efficacy, Safety, and Biomarkers.
Journal Clinical cancer research : an official journal of the American Association for Cancer Research
Vol 25
Issue 1
Date 2019 01 01
URL
Abstract Text HER2-targeted therapy is not standard of care for HER2-positive non-small cell lung cancer (NSCLC). This phase II study investigated efficacy and safety of the HER2-targeted antibody-drug conjugate trastuzumab emtansine (T-DM1) in patients with previously treated advanced HER2-overexpressing NSCLC.Eligible patients had HER2-overexpressing NSCLC (centrally tested IHC) and received previous platinum-based chemotherapy and targeted therapy in the case of EGFR mutation or ALK gene rearrangement. Patients were divided into cohorts based on HER2 IHC (2+, 3+). All patients received T-DM1 3.6 mg/kg intravenously every 3 weeks until disease progression or unacceptable toxicity. The primary endpoint was investigator-determined overall response rate (ORR) using RECIST v1.1.Forty-nine patients received T-DM1 (29 IHC 2+, 20 IHC 3+). No treatment responses were observed in the IHC 2+ cohort. Four partial responses were observed in the IHC 3+ cohort (ORR, 20%; 95% confidence interval, 5.7%-43.7%). Clinical benefit rates were 7% and 30% in the IHC 2+ and 3+ cohorts, respectively. Response duration for the responders was 2.9, 7.3, 8.3, and 10.8 months. Median progression-free survival and overall survival were similar between cohorts. Three of 4 responders had HER2 gene amplification. No new safety signals were observed.T-DM1 showed a signal of activity in patients with HER2-overexpressing (IHC 3+) advanced NSCLC. Additional investigation into HER2 pathway alterations is needed to refine the target population for T-DM1 in NSCLC; however, HER2 IHC as a single parameter was an insufficient predictive biomarker.

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Molecular Profile Treatment Approach
Gene Name Source Synonyms Protein Domains Gene Description Gene Role
Therapy Name Drugs Efficacy Evidence Clinical Trials
Drug Name Trade Name Synonyms Drug Classes Drug Description
Gene Variant Impact Protein Effect Variant Description Associated with drug Resistance
Molecular Profile Indication/Tumor Type Response Type Therapy Name Approval Status Evidence Type Efficacy Evidence References
ERBB2 G776_V777insVC ERBB2 over exp lung non-small cell carcinoma predicted - sensitive Ado-trastuzumab emtansine Case Reports/Case Series Actionable In a Phase II trial, a non-small cell lung cancer patient with ERBB2 overexpression (IHC 3+) and harboring ERBB2 G776_V777insVC demonstrated a partial response when treated with Kadcyla (ado-trastuzumab emtansine), with a duration of response of 7.3 months, a progression-free survival of 8.5 months, and an overall survival of 20.2 months (PMID: 30206164; NCT02289833). 30206164
ERBB2 amp ERBB2 over exp ERBB2 rearrange lung non-small cell carcinoma predicted - sensitive Ado-trastuzumab emtansine Case Reports/Case Series Actionable In a Phase II trial, a non-small cell lung cancer patient with ERBB2 overexpression (IHC 3+), ERBB2 amplification, and an ERBB2 rearrangement demonstrated a partial response when treated with Kadcyla (ado-trastuzumab emtansine), with a duration of response of 10.8 months, a progression-free survival of 12.2 months, and an overall survival of 12.9 months (PMID: 30206164; NCT02289833). 30206164
ERBB2 over exp lung non-small cell carcinoma predicted - sensitive Ado-trastuzumab emtansine Phase II Actionable In a Phase II trial, Kadcyla (ado-trastuzumab emtansine) treatment in non-small cell lung cancer patients who were ERBB2 positive (defined as IHC 2+ or IHC 3+) resulted in an objective response rate of 20% (4/20), with 4 partial responses, a median progression-free survival (PFS) of 2.7 mo, and a median overall survival (OS) of 15.3 mo in patients who were IHC 3+ (n=20) while patients who were IHC 2+ (n=29) had a median PFS of 2.6 mo, a median OS of 12.2 mo, and no responses (PMID: 30206164; NCT02289833). 30206164
ERBB2 amp ERBB2 over exp lung non-small cell carcinoma predicted - sensitive Ado-trastuzumab emtansine Case Reports/Case Series Actionable In a Phase II trial, a non-small cell lung cancer patient with ERBB2 overexpression (IHC 3+) and ERBB2 amplification demonstrated a partial response when treated with Kadcyla (ado-trastuzumab emtansine), with a duration of response of 8.3 months, a progression-free survival of 9.6 months, and an overall survival of 21.6 months (PMID: 30206164; NCT02289833). 30206164